hcpc’s standards of education and · 2018-11-22 · ii executive summary background the hcpc is a...
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I
Preparation for practice: The role of the
HCPC’s standards of education and
training in ensuring that newly
qualified professionals are fit to
practise
Professor Mary Chambers
Dr Gary Hickey
Giulia Borghini
Rachael McKeown
Faculty of Health, Social Care and Education Kingston University and St
George’s, University of London
I
Acknowledgements
We wish to thank the Health and Care Professions Council (HCPC) for
commissioning the research. We also wish to thank members of the Advisory Group
for their guidance, help and support throughout the project. Thanks also go to all
those colleagues in Higher Education Institutions who allowed us to use their
premises and gave us assistance recruiting participants. To all Service Users and
other study participants, we wish to acknowledge the time and energy you gave to
the project for which we are most grateful and we take this opportunity to thank you.
II
Executive Summary
Background
The HCPC is a regulator of 16 health and social care professions. Its role includes
ensuring that education and training programmes meet standards of education and
training (SETs) and that newly qualified professionals are fit to practise. These SETs
apply to all 16 professions and cover the following areas: level of qualifications for
entry to the register, admissions, programme management and resources,
curriculum, practice placements and assessment.
To ensure that the SETs are contemporary and relevant they are reviewed regularly.
It is as part of such a review that this research was commissioned.
Purpose and objectives of the project
The overall aim of this project is to explore ‘preparation for practice’ of newly
qualified professionals who have completed pre-registration education and training
programmes approved by the HCPC. Evidence gained from this project will inform
and assist the HCPC in decision-making regarding the SETs (and supporting
guidance) required when preparing newly qualified professionals to be fit to practise.
The project objectives were to:
Identify the factors (including SETs and guidance), and how they combine
and contribute towards ensuring ‘fitness to practise’
Determine how Higher Education Institutions (HEIs) implement, and
measure as outcomes, the HCPC SETs within curricula
Explore the views of healthcare managers, educators, experienced
professionals and newly qualified regarding preparedness to practise
(including the extent to which they meet the HCPC standards of proficiency)
Explore the views of newly qualified professionals, educators, students,
service users, patients, carers, practice placement educators, experienced
professionals and employers on the appropriateness and completeness of
current SETs and supporting guidance
Determine the extent to which the pre-registration education programmes
(incorporating HCPC SETs) prepare newly qualified professionals for the
challenges of interprofessional working and public and patient involvement
(PPI)
Produce recommendations for how the SETs (and their supporting
guidance and any other factors/key issues that contribute to fitness for
practice) for newly qualified professional groups regulated by the HCPC,
may be amended and/or strengthened.
III
Methods
The study was undertaken using a four-stage, interdependent sequential mixed
method approach, which includes both qualitative and quantitative methods of data
collection and analysis. Following a literature review (stage 1), an online
questionnaire survey (stage 2) was designed and circulated among our sample. The
literature review and preliminary analysis of the questionnaire data informed the
questions asked at the data collection events (stage 3), which included world cafés,
focus groups and individual interviews. Finally, a consensus workshop (stage 4) with
key informants was carried out.
Findings
The HCPC’s definition of ‘fitness to practise’ is consistent with that of other
professions and regulators. There is one issue, included in the General Medical
Council’s definition, and not elsewhere, that relates to the relationship between the
practitioner and patient. Our research findings also revealed concern, often from
service users, that some health and social care professionals are unable to relate to
service users in an appropriate way.
Generally speaking newly qualified professionals were regarded as adequately
prepared for practice albeit with some concerns about the ability of some to relate to
service users and carers. There were also concerns about the impact of the
variability of both the placement experience as well as the role and training of the
practice educator.
The data suggests that the vast majority of respondents see the standards as either
very important or important regarding ensuring fitness to practise, and that there was
no appetite for additional SETs. Course directors are more likely to rate the
standards as very important or important. For every standard 80% of course
directors rated it as either important or very important. Both course directors and
newly qualified professionals were most likely to rate the standards relating to
‘practice placements’ as important, with all being rated by 90% as very important or
important.
The standards relating to ‘programme management and resources’ produced the
lowest percentages of newly qualified professionals who rated them as very
important or important.
Where issues were raised with the standards they tended to be a concern about how
best to implement them. There was a recognition that SETs, that have to cover 16
professions, will need to be generic so as to provide sufficient flexibility rather than
specific and prescriptive. It is the SoPs and the requirements of professional bodies
which provide more profession specific criteria. Currently, however, some
respondents reported that these different standards and requirements are not
sufficiently joined up.
IV
SET 2.2 states that ‘The admissions procedures must apply selection and entry
criteria, including evidence of a good command of reading, writing and spoken
English.’ Our findings showed that there were variations in how ‘good command’
was interpreted and applied.
SET 2.4 states that ‘The admissions procedures must apply selection and entry
criteria, including compliance with any health requirements.’ The findings revealed
concerns about the lack of clarity on this and also that the HCPC does not make
explicit mention of mental health.
SET 3.17 states ‘Service users and carers must be involved in the programme.’ The
results have shown that some HEIs struggle to involve service users and carers
effectively.
Despite the importance of effective collaboration between professions, there have
been a number of difficulties for some HEIs in implementing interprofessional
learning within the curriculum.
In terms of practice placements, the findings indicate huge variety in the placement
experience. Key issues are the length of placements, the difficulties of matching
theory and practice and lack of clarity of the role of practice educator.
SET 6.5 states ‘The measurement of student performance must be objective and
ensure fitness to practise’. Some respondents were concerned about how much
objectivity was actually possible especially as the measurement of student
performance ‘must be objective’.
SET 6.9 includes the word ‘aegrotat’. Many respondents were unclear of the
meaning.
Recommendations
The findings presented the following recommendations to be considered by the
HCPC.
Recommendation 1 The HCPC should consider adding a reference to the
development of relationships with service users to their
definition of fitness to practice
Recommendation 2 The HCPC should consider making an explicit mention of ‘soft
skills’ within current SETs
Recommendation 3 The HCPC’s SETs and guidance should include stronger links
to SoPs and HCPC’s standards of conduct, performance and
ethics, and also the standards and requirements of
V
professional bodies.
Suggestions include:
URL link
Explicit link within the introduction to the SoPs and
standards of conduct, performance and ethics, and
professional body guidance
Recommendation 4 The HCPC to consider providing a minimal IELTS score for
students whose first language is not English, seeking a place
on HCPC regulated courses
Recommendation 5 The HCPC to make a clear link, in their SETs and guidance, to
the document ‘Health, disability and becoming a health and
care professional’
Recommendation 6 The HCPC to make explicit mention of ‘mental health’ within
the SETs or guidance
Recommendation 7 The HCPC to review practice educator training with a view to
developing broad principles about the role of practice
educators
Recommendation 8 The HCPC to consider the development of a ‘how to’ practice
guide to complement the SETs and the guidance
Recommendation 9 Re-word the SET 6.5. Suggestions are:
Replace ‘must’ with ‘should aim to be’
o ‘The measurement of student performance
should aim to be objective and ensure fitness
to practise’
Replace ‘objective’ with ‘fair’, ‘rigorous’, or ‘uniform’
o ‘The measurement of student performance
must be fair/rigorous/uniform and ensure
fitness to practise’
Keep ‘objective’ but include ‘fair’, ‘rigorous’ and
‘uniform’ too
o ‘The measurement of student performance
must be objective, fair, rigorous, uniform and
ensure fitness to practise’
Recommendation
10
Recommendation 10: Define the word ‘aegrotat’ within SET
6.9 using the definition of aegrotat provided within the
glossary.
E.g. ‘Assessment regulations must clearly specify
requirements for an aegrotat award (awarded to a
student who cannot complete the degree due to
illness) not to provide eligibility for admission to the
Register’
VI
Table of Contents
Acknowledgements I
Executive Summary II
Chapter 1- Introduction
1.1 Introduction 1
1.2 Aim 1
1.3 Objectives 1
1.4 Background 2
1.5 Key developments covered by the research 3
1.6 Summary 4
Chapter 2- Literature review
2.1 Introduction 6
2.1.1 Search strategy 6
2.1.2 Search results 7
2.1.3 Research methodologies identified from current literature 8
2.2 Fitness to practice 9
2.3 Programme admissions 12
2.4 Programme management and resources 14
2.5 Curriculum 15
2.5.1 Methods of teaching 17
2.6 Practice placements 19
2.6.1 Practice educators 21
2.7 Assessment 23
2.7.1 Lack of student confidence 25
2.8 Service user involvement 26
2.9 Interprofessional education 26
2.10 Conclusion 28
Chapter 3- Methodology
3.1 Introduction 30
3.2 Stage 1: Literature review and development of a matrix 30
3.3 Stage 2: On-line questionnaire survey 31
3.3.1 Questionnaire design and implementation 31
3.3.2 Data analysis 32
3.4 Stage 3: Data collection events 33
VII
3.4.1 Venues’ selection and participants’ recruitment 33
3.4.2 Event design and implementation 37
3.4.3 Data analysis 38
3.5 Stage 4: Consensus workshop 39
3.6 Ethical approval 40
Chapter 4- Findings
4.1 Introduction 41
4.2 Survey respondents 41
4.3 Programme admissions 44
4.3.1 Command of English 45
4.3.1.1 Defining ‘good command’ of English 45
4.3.2 Health requirements 47
4.3.2.1 Variations between health admission SETs 47
4.3.3 Interviews 49
4.3.4 Life experience 50
4.4 Programme management and resources 51
4.4.1 Students participating as service users 52
4.4.2 Mandatory attendance 53
4.4.2.1 Attendance on placement vs. attendance in education 53
4.4.3 Service user involvement 55
4.4.3.1 Value of service user involvement 55
4.4.3.2 Where should service users be involved? 56
4.4.3.3 Getting service users involved: risks, representativeness
and resources 56
4.5 Curriculum 57
4.5.1 Theory and practice 58
4.5.2 Evidence-based practice 59
4.5.3 Interprofessional education 60
4.5.3.1 Value of interprofessional education 60
4.5.3.2 Balancing profession specific skills and knowledge with
IPE 61
4.5.3.3 Making IPE happen 61
4.6 Practice placements 62
4.6.1 Number, duration and range of placements 63
4.6.1.1 Variation between placements 63
4.6.1.2 Issues with practice placements 64
4.6.2 Role of practice educators 65
4.6.2.1 Benefits of practice educators 66
4.6.2.2 How trained or qualified should practice educators be? 66
4.7 Assessment 68
4.7.1 Can an assessment be ‘objective’? 68
4.7.2 Aegrotat award 69
VIII
4.8 What is not covered by the SETs? 70
4.8.1 Personal characteristics and attributes 70
4.8.2 Peer support 71
4.8.3 Clinically active staff 72
4.9 How aware are people of the SETs? 73
4.10 Other issues 73
4.10.1 SETs are useful 73
4.10.2 Generic or specific SETs? 74
4.11 What is ‘fit to practice’? 75
4.11.1 Are newly qualified professionals fit to practice? 76
4.11.2 Managing expectations of practice 77
4.11.3 Supporting newly qualified professionals 78
4.12 Summary of findings 79
4.13 Consensus workshop 80
4.13.1 Group discussion 80
4.13.2 Variety and quality of placements 80
4.13.3 The role of the practice educators 81
4.13.4 Can assessments ever be ‘objective’? 81
4.13.5 Importance of personal characteristics 81
4.14 Conclusion 81
Chapter 5- Discussion
5.1 Introduction 83
5.2 SETs are regarded as important in terms of ensuring fitness to practise of
newly qualified staff 83
5.3 The HCPC’s definition of fitness to practice is consistent with that of other
professional bodies and regulators 83
5.4 Generic and flexible SETs vs specific and prescriptive SETs 85
5.5 How SETs are implemented 85
5.5.1 Command of English 86
5.5.2 Health requirements 87
5.5.3 Service user involvement 88
5.5.4 Interprofessional education 88
5.5.5 Management of practice placements 89
5.5.6 Addressing the ‘how’ issue 90
5.6 Suggestions to reword SETs 91
5.7 Conclusion 92
5.8 Limitations of the research 93
5.8.1 Developing the questionnaires 93
5.8.2 Respondents of the online survey 93
5.8.3 Number of respondents in data collection events 93
5.8.4 Service user and carer involvement in data collection events 94
5.8.5 Student involvement in data collection events 94
IX
5.8.6 Naming data quotations 94
References 95
Appendices
Appendix 1: Example of literature review matrix table 105
Appendix 2: Literature review data collection matrix table 107
Appendix 3: The SETs 113
Appendix 4: Definitions of fitness to practise 116
Appendix 5: Questionnaire for Course Directors 119
Appendix 6: Questionnaire for newly qualified, experienced professionals, pre-
registration student supervisors and service directors/managers 131
Appendix 7: Topic guide for mixed focus group 138
Appendix 8: Topic guide for service user focus group 140
Appendix 9: Topic guide for world café events 141
Appendix 10: Topic guide for individual interviews 143
Appendix 11: Consensus workshop results 145
Appendix 12: Compendium of practice examples 148
Tables and Figures
Table 1: Venues, disciplines and professional roles from data collection events 34
Figure 1: Professional roles from online surveys 42
Figure 2: Professions represented in online surveys 42
Figure 3: Geographical location from online surveys 43
Figure 4: Practice placement SETs considered very important/important 44
Figure 5: Programme management and resources SETs considered very
important/important 51
Figure 6: Curriculum SETs considered very important/important 58
Figure 7: Practice placement SETs considered very important/important 62
Figure 8: Assessment SETs considered very important/important 68
X
1
Chapter 1 Introduction
1.1 Introduction
The Health and Care Professions Council (HCPC) is a regulator of 16 health and
social care professions. Its role includes ensuring that education and training
programmes meet standards of education and training (SETs) and that newly
qualified professionals are fit to practise. To ensure that the SETs are contemporary
and meaningful they are reviewed regularly. It is as part of such a review that this
project was commissioned.
This chapter outlines the context and background to the project. The chapter begins
by providing information on the aim and objectives to the project. It then provides
information on the background to the project; the definition of fitness to practise used
by the HCPC and explains some of the key developments in health and social care.
The HCPC’s definition is used throughout this project.
Chapter two is a literature review that includes previous work (from other health and
social care professions as well as those regulated by HCPC) on fitness to practise as
well as an exploration of the different definitions of key concepts used within the
literature.
A description of the data collection methods employed in the project are described in
chapter three while chapter four outlines the project findings. Chapter five provides a
discussion of the key issues including recommendations and the limitations of the
project.
1.2 Aim
The overall aim of this project is to explore ‘preparation for practice’ of newly
qualified professionals who have completed pre-registration education and training
programmes approved by the HCPC. Evidence gained from this project will inform
and assist the HCPC in decision-making regarding the SETs (and supporting
guidance) required for preparing newly qualified professionals to be fit to practise.
1.3 Objectives
Identify the factors (including SETs and guidance), and how they combine
and contribute towards ensuring ‘fitness to practise’
Determine how Higher Education Institutions (HEIs) implement, and
measure as outcomes, the HCPC SETs within curricula
Explore the views of healthcare managers, educators, experienced
professionals and newly qualified professionals regarding preparedness to
practise (including the extent to which they meet the HCPC standards of
proficiency)
2
Explore the views of newly qualified professionals, educators, students,
service users, patients, carers, practice placement educators, experienced
professionals and employers on the appropriateness and completeness of
current SETs and supporting guidance
Determine the extent to which the pre-registration education programmes
(incorporating HCPC SETs) prepare newly qualified professionals for the
challenges of interprofessional working and public and patient involvement
(PPI)
Produce recommendations for how the SETs (and their supporting
guidance and any other factors/key issues that contribute to fitness to
practise) for newly qualified professional groups regulated by the HCPC,
may be amended and/or strengthened
1.4 Background
When assessing education programmes the HCPC employ a set of standards.
These SETs cover the following areas: level of qualifications for entry to the register,
admissions, programme management and resources, curriculum, practice
placements and assessment. The SETs are common across all 16 professions
regulated by the HCPC. In turn, a programme which meets the SETs allows a
student who successfully completes that programme to meet the standards of
proficiency (SoPs) - the threshold standards for safe and effective practice in each
profession. If a student successfully completes the approved programme they are
eligible to apply for registration with the HCPC (subject to health and character
checks and payment of the registration fee).
Accompanying the SETs is guidance, which provides advice to education and
training providers on how programmes will be assessed and monitored against the
SETs. The focus of the SETs and guidance are on the outcomes of the education
and training programmes i.e. the ability of those completing the programmes to
practise safely and effectively.
HCPC reviews their SETs approximately every five years and were last updated in
2009. The project reported on here is one of three strands of work reviewing the
SETs and supporting guidance. A second strand is research relating to
interprofessional education while a third is internal HCPC research and stakeholder
engagement activities to gather views on the SETs.
This project explores the role played by the SETs and supporting guidance in
ensuring that education providers have the structures and systems in place to
prepare students to be fit to practise at point of entry to the Register. The intention is
to identify whether and how the SETs and/or supporting guidance should be
strengthened and programmes modified as a result.
3
It is not just education providers upon whom the SETs impact. They also have
implications for students on HCPC approved courses, newly qualified staff as well as
more experienced professionals. It is vital that any review of these SETs include this
range of people.
Defining fitness to practise
The HCPC have separate definitions of fitness to practise for students and
registrants i.e. staff who are qualified. Fitness to practise for students means
‘have(ing) the necessary health and character so that they will be able to practise
safely and effectively once they have become registered. It is also about students’
ability to act appropriately with those they have come into contact with when they are
training, including service users’ (HCPC, 2011). Fitness to practise for registrants is
defined as having the ‘skills, knowledge, health and character in order to practise
their profession safely and effectively’ (HCPC, 2011). This project is focussed on the
latter. The key differences between fitness to practise for students and registrants
are that registrants need the skills and knowledge, as well as the health and
character, to practise safely and effectively. The phrase ‘newly qualified’ will be used
in the rest of this project to refer to registrants; this is a term more easily understood
by stakeholders.
A distinction should also be made between being fit to practise with being fit for
purpose. The latter is the responsibility of employers and is about whether an
employer regards an individual as having the knowledge, understanding, skills and
experience to make them suitable for any given role or to work within any given
setting.
Inevitably this project raises issues touching upon the role that employers can play in
enabling newly qualified staff to undertake their role. However, the focus of this
project is on the HCPC SETs and supporting guidance - employers will always be
responsible, e.g. via preceptorship, induction, training and supervision, in supporting
newly qualified professionals in their transition into practice.
Chapter two provides a fuller exploration of definitions of fitness to practise used
within the health and social care professions.
1.5 Key developments covered by the research
There are several factors driving the changes to the health and social care system
and subsequently, the knowledge and skills required of health and social care
practitioners. These include an ageing population, frequently with long term
conditions, children born with complex conditions who can now be expected to reach
adulthood, growing emphasis on chronic illnesses, greater focus on patient safety
and quality care (Bainbridge, 2010).The long term care and support needed puts
demand on the health and social care system and the skills required of the
workforce. Other significant developments are the advent of consumerism, a more
4
diverse and discerning population and the rising cost of health and social care. In
addition, technology has advanced and roles are rapidly expanding, which not only
broadens levels of autonomy but intensifies the demand for new knowledge and
skills (Whiting, 2009).
Two particularly important developments, which were explicitly addressed in the
project, are the need for interprofessional working and the requirement to engage
effectively with service users and carers.
Interprofessional working
The consequences of inadequate collaborative working were highlighted in both the
tragic case of Baby P (Laming, 2009) and the scandal at Mid Staffordshire
Foundation Trust which resulted in the Francis Report (2013). Both reports illustrate
how poor team-working and communication between professionals can have a
hugely negative impact on the delivery of patient care. The Health and Social Care
Act (2012), and the National Collaboration for Integrated Care and Support (2013),
emphasise the need for effective collaborative working between professions to
provide integrated, optimal and safe patient care. This has consequences for how
health and social care professionals are prepared for practice. The delivery of
modern healthcare is dependent on groups of trained professionals coming together
as interdisciplinary teams (WHO, 2013).
Service user and carer involvement
No longer is it acceptable for people to be passive recipients of services; they want
to be involved in decisions about their care and treatment. The Alliance of Health
Care Regulators in Europe (AURE) has argued that service user and carer
involvement in healthcare regulation should be regarded as good practice (Joint
Health and Social Care Regulators’ Patient and Public Involvement Group, 2010).
This is echoed in the UK White Paper, ‘Trust, Assurance and Safety – The
Regulation of Health Professionals in the 21st Century’ (DH, 2007), which advocates
greater service user and carer involvement. In recognition of the importance of
service user and carer involvement, the HCPC commissioned research into
developing a SET that would cover this issue (Chambers & Hickey, 2012);
subsequently a SET was introduced specifying service user involvement in the
design and delivery of courses. The recent Willis Report, which reviewed the
education and training of care staff and nurses, recommended that Health Education
England should seek to identify those forms of public and patient involvement that
can support learning and incorporate the findings into standard and quality
assurance processes.
1.6 Summary
The HCPC reviews its SETs, and supporting guidance, on approximately a five year
cycle – the last time they were reviewed was in 2009. The focus of the HCPC’s SETs
and guidance are on the outcomes of education and training programmes i.e. the
5
ability of those completing the programmes to practise safely and effectively. This
research reviews the SETs and guidance against a backdrop of key developments
driving the changes to the health and social care system and subsequently, the
knowledge and skills required of health and social care practitioners. These key
developments, and included in this research, are the need for interprofessional
working and the requirement to engage effectively with service users and carers.
6
Chapter 2 Literature review
2.1 Introduction
This chapter is a literature review which explores different definitions of fitness to
practise, reviews previous research on fitness to practise, identifies factors that
impact upon fitness to practise, and compares standards, guidance and approaches
used by different professions to ensure fitness to practise.
The chapter also outlines the search strategy used for the review and provides a
commentary on the methods employed in the literature reviewed. For the purpose of
simplicity the literature review has been organised using the HCPC’s headings for
their SETs.
The outcomes of the review provided context to the project and informed the focus
and content of the subsequent questionnaire, focus groups, world café events and
individual interviews.
2.1.1 Search strategy
Literature was identified through systematic searches of the electronic databases
Ovid Medline, Cumulative Index of Nursing and Allied Health (CINAHL) and Applied
Social Science Index and Abstracts (ASSIA) and further manual examination of
reference lists. The search of journal articles was narrowed according to the
following criteria:
date of publication from 2000 to 2015
written in English,
peer reviewed, and
other relevant literature identified from the articles in the review.
These searches were carried out in April and May 2015.
Only articles, which were available free of charge were considered. Using advanced
search facilities, the phrases ‘fitness to practise’, ‘fitness for practice’, ‘suitability to
practise’ and ‘preparedness to practise’ were searched with each profession. The
terms ‘qualification’, ‘registration’, ‘regulation’, ‘education’, or ‘professional standard’
were compared alongside each of the professions: ‘speech and language’,
‘radiographer’, ‘prosthetist’ or ‘orthotist’, ‘practitioner’, ‘paramedic’, ‘orthoptist’,
‘dietitian’, ‘chiropodist’ or ‘podiatrist’, and ‘therapist’. The following terms were also
considered, ‘students, undergraduate’, ‘practice patterns’, ‘health knowledge’ or
‘attitude of health personnel’.
This advanced search method initially generated thousands of possible articles and
these were shortlisted using Microsoft Excel, reduced by the limiting factors, listed
above, and removal of duplicates. The accumulated articles deemed most relevant
7
for the study: 266 from CINAHL, 574 from Medline, and 32 from ASSIA.
Subsequently, a process of rigorous sifting followed with a screening of these articles
by title and abstract. This process enabled the researchers to discard irrelevant
articles, resulting in 40 unique papers from CINAHL, 44 from Medline and 31 from
ASSIA.
The remaining journal articles identified for inclusion in the review were subject to
detailed examination and appraisal. The methods and major findings of individual
papers were summarised within a matrix table (see Appendix 1).
2.1.2 Search results
The literature search included other health and social care disciplines not under the
HCPC umbrella (medicine, midwifery, nursing, pharmacy, physical therapy, public
health, dentistry, mental health, audiology, respiratory therapy, physician assistance,
general practitioners and support care) in order to widen our understanding of
current knowledge. Although the majority of the research was focused in the UK (n=
53) this literature review also includes papers from other countries (Australia,
Belgium, Canada, Germany, Hong Kong, Ireland, Israel, New Zealand, South Africa,
South Korea, Sweden and United States).
The most frequently mentioned group of professionals was student nurses (n=38)
who are registered and regulated in the UK by the Nursing and Midwifery Council
(NMC), not the HCPC. The relatively large number of papers on nursing may be due
to the size of the profession and visibility within the health care setting.
Importantly, the literature reviewed identified papers representative of HCPC
professions: social work, physiotherapy, occupational health therapy, psychology,
nutritionists, paramedics and speech language therapy. Of these, social work was
the most heavily represented (n=23). Additional factors might include the relatively
large size of the profession and public fears regarding system failures in
management and professionalism. The high-profile examples have demonstrated the
need for ensuring fitness to practise in safeguarding the public and service users.
The tragic cases of Daniel Pelka and Keanu William have contributed to research-
based recommendations to be made within the profession (Narey, 2014). Noticeably,
nine of the HCPC’s regulated professions do not appear in this search strategy and
within these databases: arts therapy, biomedical science, chiropody, clinical science,
hearing aid dispensers, operating department practitioners, orthoptics, prosthetics
and radiography.
A challenge in examining the published research was the lack of a common
definition for fitness to practise, making comparisons between reports difficult.
Most of the articles assessed students’ perceptions of their own level of competency
to practice (n=39). Previous students’ and graduates’ opinions were also uncovered
8
(Bullock et al., 2013; Hartmann et al., 2013; Hylin et al., 2007). Newly qualified
professionals were considered by a number of papers (Avis et al., 2013; Black et al.,
2010; Caldwell et al., 2006; Caldwell et al., 2007; Derbyshire & Machin, 2011;
Young, 2011) as were qualified and registered professionals (Findlay, 2012; Fraser,
2000a; Fraser, 2000b; Green et al., 2007; Hartigan et al., 2010; O’Connor et al.,
2012; Paterson et al., 2007; Stanley et al., 2011; Tam et al., 2012). An obvious
weakness in self-reflection of preparedness is the lack of objectivity in such
assessments.
There were though, a number of articles that considered the perceptions of clinical
educators (Bandali et al., 2012; Fraser, 2000a; Fraser, 2000b; Gibbs & Furney,
2013; Holland et al., 2010; McAllister et al., 2013; Reeves & Freeth, 2002; Wilson &
Carryer, 2008), lecturers (Holland et al., 2010) and course directors (Boyd & Spatz,
2013). Additionally, some papers considered the input of supervisors or student
mentors (Brintworth, 2014; Fraser, 2000a; Fraser, 2000b; Gunn et al., 2012; Holland
et al., 2010; Young, 2011). A few papers also consulted service users and carers
about the level of care they receive (Holland et al., 2010; Reeves & Freeth, 2002).
2.1.3 Research methodologies identified from current literature
Previous research has utilised a diverse range of data collection methods to uncover
opinions of student preparedness for clinical practice (highlighted in Appendix 2).
Focus groups, interviews and questionnaire approaches were common methods of
highlighting experiences. A smaller number of papers employed other methods such
as workshops, ethnography and examination of self-reflective diary entries (see
Appendix 2). Other studies offered a longitudinal element (Black et al., 2010;
Fineberg et al., 2004; Jackson et al., 2006; Rees & Raithby, 2012; Reeves & Freeth,
2002; Ross & Haidet, 2011; Tee & Jowett, 2009; Webster et al., 2010), comparing
perceptions from different time frames; some studies used a mixed method
approach.
Most studies were small-scale, analysing results from one or two institutions or
studying one or two professions.
The variety of professions, countries covered and methodologies used means that
any conclusions should be treated with extreme caution.
Analysis of this literature follows the same structure as the HCPC’s grouping of SETs
(see Appendix 3 for full list of SETs). Evidence is presented, critiquing the SETs and
any challenges posed; there is overlap between the SETs as they implicate each
other.
9
2.2 Fitness to practise
The literature explores definitions of ‘fitness to practise’ (Avis et al., 2013; Fraser,
2000a; Holland et al., 2010; Holstrom, 2014; Moriarty et al., 2011; Parker, 2006;
Stanley et al., 2011; Unsworth, 2011). Much of the literature uses terminology
without fully explaining what it means (Brintworth, 2014; Christiansen & Bell, 2010;
Lauder et al., 2008; Tee & Jowett, 2009; Whiting, 2006; Wilson & Carryer, 2008).
Furthermore there is a lack of agreement around definitions of fitness to practise
(Grundy, 2011).
Fitness to practise represents an amalgamation of many factors contributing to the
preparedness of an individual to confidently enter their chosen clinical profession
with appropriate and expected levels of capacity, capability and expertise. How
individuals achieve these rests with the Higher Education Institution (HEI) and the
design of their courses. The HEIs need to ensure specific SETs of education and
training to guarantee that each student is confident and competent at the point of
graduation to become registered.
Appendix 4 presents definitions of ‘fitness to practise’ of various professional
regulatory bodies. HCPC define fitness to practise as someone having the:
“Skills, knowledge, health and character in order to practise their profession safely
and effectively’ (HPC 2011)”
Fitness to practise is often defined in terms of what is ‘unfit’ – focusing on the
negatives and the opposites of these actions. For example, when defining fitness to
practise the HCPC (2003) uses language of ‘impairment’ and outlines situations
when a registrant may be considered as ‘impaired’ by falling short of specified SETs.
Holmström (2014, p.459) has criticised the HCPC for using reductionist language to
what is deemed an absence of ‘bad character’ in relation to (un)professional
behaviour. Unsworth (2011) critiques nursing students’ fitness to practise
mechanisms for focusing on academic achievements, as opposed to the students’
personal competency levels. A holistic model for defining competency provides
better indicators, as opposed to being broken down into a list of specified criteria
(Fraser, 2000b). Moriarty et al. (2011) have suggested that student preparedness
should not be viewed as an end product but instead a process of continual
development.
Other Regulatory Body Definitions
The role of fitness to practise amongst all regulators in the UK is crucial as the NHS
Executive (2000) has stated that there must be a ‘modernising education and
training to ensure that staffs are equipped with the skills they need to work in a
complex, changing NHS’. Appendix 4 gives the definitions from the other regulatory
bodies operating within the UK and provides a good comparative base for the
definition provided by the HCPC. For some, these variations in measuring and
10
defining fitness to practise highlight a need for uniformity across all regulatory bodies
to ensure standards (Tee & Jowett, 2009). Currer (2009) has suggested that it is
essential for a common definition of competencies to be developed. The need for a
uniform approach has also been advocated by Meerabeau (2001, cited in Holland et
al. 2010, p.463) who states that without an appropriate and agreed benchmark then
judgements on whether expectations have been met will also vary.
Within recent years some other health regulatory bodies have reviewed
fitness/preparedness to practice and the implications of this upon their professional
standards.
The General Dental Council (GDC) assessed the extent to which new registrants
pose a risk to patients and the public, collecting data from patient and public surveys,
questionnaire, stakeholder events and a literature review (Pierce, Kavanagh & Das,
2013). While recognising that risk can never be totally removed from clinical
situations, the report concluded that newly qualified dentists do not pose a risk to the
public. The literature review highlighted that graduates are most confident in those
areas in which they received most experience while training; oral surgery,
orthodontics and endodontics were specific areas that newly qualified professionals
reported low skill and confidence. The report recommends further research
supporting newly qualified professionals within the workplace, specifically those from
outside the UK transitioning to a new setting.
The General Osteopathic Council (GOsC) undertook an in-depth study with a
questionnaire and focus groups, gathering the views of faculty staff and final year
students. Results acknowledge the multifaceted nature of preparedness to practise;
they assert that the ‘bed-rock’ of preparation comes from clinical knowledge and
competence that is supported by interpersonal and communication skills (Freeth,
McIntosh & Carnes, 2012). The GOsC explored the notion of “safe if not always
effective” which has been used to determine if students are prepared to enter
practice. However, they note that focusing on the extent to whether newly qualified
professionals are ‘safe’ can lead to overlooking the importance of interpersonal skills.
This report suggests that these interpersonal skills should be better implemented
within the curriculum and there should also be a greater emphasis on support
systems for newly qualified professionals.
The General Medical Council (GMC) reviewed the extent to which newly qualified
doctors felt they were prepared for practice by studying different teaching styles in
three different universities – Newcastle, Warwick and Glasgow (Illing et al., 2008).
Results showed that they felt well prepared in basic clinical skills and communication
but felt under-prepared for assessing more difficult cases, managing workloads and
prescribing. A proffered solution was for students to gain more experiential learning
and clinical practice, especially within their final year of study. The study
acknowledged existing variation between placements. It suggested the need to
11
develop a ‘learning culture’ within placement settings, where staff encourage the
student’s progression and learning routinely rather than only the educator
contributing during specific time-frames. The report raised some concerns from
educators that too much focus was being placed on ‘softer skills’, such as
communication, leading to less dedication to skill development.
A subsequent study by Monrouxe et al. (2014), and commissioned by the GMC,
looked at the extent to which current UK medical graduates are prepared for
practice. They undertook a Rapid Review of the literature between 2009 and 2013,
interviews with a range of stakeholders and longitudinal audio-diaries with
Foundation Year 1 doctors. Some of the findings echo those of Illing et al. (2008) as
most trainees were not prepared for adopting a holistic understanding of the patient
or involving patients in their care. They were also not prepared for safe and legal
prescribing, diagnosing and managing complex clinical conditions and providing
immediate care in medical emergencies. The trainees were well prepared for some
practical procedures but not others, and reasonably well prepared for history taking
and full physical examinations.
The General Optical Council (GOC) conducted qualitative research with students to
assess whether they feel prepared for practice (Council for Healthcare Regulatory
Excellence, 2012). From this research the consensus was that generally students did
feel well prepared, but suggested two improvements; the development of modules
with clinical scenarios and additional placements to increase student exposure to
unusual and unfamiliar conditions.
These bodies regulate different professions and therefore have slightly differing
ideals regarding fitness to practise, some emphasising the necessity of clinical skills
over interpersonal skills with others viewing them as equally important. Issues that
emerged, from the reviews, as needing addressing were increased practical
experience and greater support for staff post qualification. The need for interpersonal
or softer skills also emerged as an issue; interestingly the report by the GMC
suggested that there was too much emphasis on this while GOsC called for a greater
emphasis. A key difference with the HCPC is that it regulates 16 professions rather
than one. It follows that the HCPC has to ensure that its SETs and definition of
fitness to practice are applicable to all 16 of these professions.
Appendix 4 shows various definitions of ‘fitness to practice’ across a range of
professions. Common themes are that professionals who are ‘fit to practise’ can do
so ‘safely and effectively’, which is included in the HCPC’s definition. Other common
themes are that the professional should have a level of ‘competence’, ‘skills’
‘performance’ or ‘knowledge’ – the HCPC go with skills and knowledge. ‘Health’ is
also a recurring theme – again this is included in the HCPC definition. ‘Character’
and an absence of misconduct or inappropriate behaviour are also frequently
mentioned – the HCPC refer to ‘character’. Not explicitly included in the HCPC’s
12
definition, and included in the GMC’s definition, is the issue of being able to
‘establish effective relationships with patients and maintain effective relationships
with patients’. It could be argued that the HCPC’s notion of a relationship between
the practitioner and patient is implicit in the phrasing ‘safely and effectively’.
2.3 Programme admissions
The admissions procedure is the first point of contact between the prospective
student and the HEI. HCPC has outlined criteria to be considered during the
admissions process – command of the English language, criminal conviction checks,
appropriate academic and prior learning and disclosure of any health impairments.
Largely, the literature had little to say on the relationship between the admissions
procedure and fitness to practise. Lauder et al.’s (2008) cross-sectional survey of
777 nursing and midwifery students concluded that the HEI is best-placed to decide
whether a student is, or is not, potentially capable to complete the course.
Key issues that emerged from the literature related to the ethics of having to disclose
health issues, the declaration of previous criminal convictions and the compatibility of
personal attributes with the requirements of a course.
Health issues
Regarding the ethical issues surrounding disclosure of health status, Stanley and
colleagues (2011) studied the extent to which students perceive that disclosure of
disability or mental health problems may prevent acceptance onto courses. In this
study of 60 practitioners and students for nursing, social work and teaching, results
showed that three students did not disclose and a further eleven only partially
disclosed information pertaining to a health condition due to fears of stigma and
exclusion. The majority of students, however, were happy to make their disabilities
known as it is essential in eliciting support where it may be required. Furthermore,
the authors concluded that in order for equality and disabilities to be celebrated
within the workplace they need to be acknowledged in the education setting (Stanley
et al., 2011). The Equality Act (2010) makes it unlawful to discriminate against
disability within education settings.
Criminal conviction checks
The HCPC’s guidelines request for criminal convictions to be uncovered through the
Disclosure and Barring Service (DBS) checks prior to admissions onto HEI
programmes. Tee & Jowett (2009) studied nursing and midwifery students within one
university setting and suggest that previous acts of criminality should be revealed
through self-declaration as a means of promoting honesty and self-reflection.
Convictions can expire after time has been spent. However, there is the view that
both health and criminal convictions should be rigorously checked as a means of
safeguarding the public (Burns et al., 2004) particularly as many service users of
healthcare are vulnerable (Harris & Keller, 2005).
13
Personal characteristics and attributes
A common theme across the literature was the compatibility of students’ personal
attributes with health professions, which is not currently explicitly addressed by the
SETs. Holmström’s (2014) literature review has suggested that attitudes ought to
have equal weighting of importance as academic strengths. Specific individual
qualities are referenced as imperative for healthcare professionals: sensitivity
(McAllister et al., 2013), maturity, initiative and communication skills (Fraser, 2000a).
Similarly, Beccaria et al. (2013) reviewed nursing through online surveys and focus
groups totalling 85 respondents and have suggested a more holistic stance would
recognise emotional competencies that are necessary within nursing. O’Connor et al.
(2012) believe that it is necessary to contemplate the ways in which age and
previous life experience may lead to greater motivation levels and development of an
‘emotional IQ’ – this was as a result of 20 individual interviews with representatives
from physiotherapy and occupational therapy.
Through a systematic literature review Parker (2006, p.401), however, has deemed
the process of screening individuals based on their personalities as ‘counterintuitive’
because it should not be assumed that students have emotional competencies at the
point of entering onto courses. Instead Parker (2006) believes the focus should
remain on academic rigour, specific skills and reasoning abilities.
Attitudes and beliefs was another issue raised in the literature. Students will always
reflect a diversity of attitudes and beliefs – thus, judgements regarding the
appropriateness of individual moral frameworks are by definition value-laden. While
Whiting (2006) asserts that morality and behaviour are closely linked. His personal
commentary focusing on the impact of student beliefs found that not all prejudices
and racist attitudes will necessarily lead to unprofessional behaviour. This suggests
that fitness to practise only becomes a concern when students are unable to
suppress these attitudes (Whiting, 2006).
Other research suggests that compassion can also present challenges. Holmström
(2014, 454) has suggested that while there are positives associated with selecting
compassionate persons, there may be ‘too much of a good thing’ if students are then
unable to control their emotions during difficult situations or periods of stress. Similar
views have been echoed by McAllister et al. (2013) and Wilson and Carryer (2008),
suggesting that being over sensitive and emotionally immature can hinder the ability
to perform.
There are similarities here with the notion of person-centred care. Laird et al. (2015)
note that people have a right to compassionate care and that knowing the service
user, working with their values and beliefs as well as developing positive
relationships are all common aspects of person-centred practice.
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2.4 Programme management and resources
Effective management of the course and utilisation of resources within HEIs is
perceived by the HCPC as crucial in producing students who are fit to practice. Key
issues emerging from the literature are effective management, the role of staff and
availability of resources.
Effective management
Ho et al.’s (2008) literature review stresses the need for the course to be funded and
organised in a structured and efficient manner. The role of academic staff in ensuring
effective management is noted in the literature - the professional responsibility and
subsequent behaviours of academics is equally important to the SoPs students are
measured against (Currer, 2009). Successful courses (specifically in
Interprofessional Education) require dedicated staff, passionate and committed to
their discipline (Ho et al., 2008). Cook and Payne (2012) have acknowledged,
however, the potential cost implications of recruiting staff who are outstanding in
their roles.
Positive models of staff management have been developed and described in the
literature. Cook and Payne (2012) propose the use of a ‘Quality Circle’ in which a
feedback loop is created; supervision improves education at operational and
strategic levels, in turn benefiting supervision. Co-operation amongst staff and
between different faculties is appreciated in improving the organisation and delivery
of healthcare profession courses (Vanier et al., 2013). A successful example of co-
operation is outlined in Vanier and colleagues’ 2013 multi-disciplinary review of
curriculum from ten different institutions; the Welsh Association of Midwifery
Lecturers was established, and tutorial staff valued the informal nature of
communication and sharing of ideas.
Role of staff
Professional teaching staff employed in HEIs frequently have to juggle the demands
of teaching, management and clinical practice. O’Connor, Cahill and McKay (2012,
p.281) highlight the ‘dual’ nature of juggling teaching and management. Lecturers
may also engage in clinical practice work, requiring further time commitments (Cook
& Payne, 2012). Raque-Bogdan et al. (2012) have critiqued the lack of clinically
active staff, supposing that without healthcare experience such lecturers may not be
best placed to educate students.
Availability of resources
The availability of resources has been highlighted as useful in the development of
students as competent professionals. Callaghan et al.’s (2008) focus groups of
fourteen students from midwifery and social work stress the importance of utilising
services, such as the library, to increase the validity and accuracy of information that
students have at their disposal. Alongside this there is a need for developing an
environment that supports and encourages students to progress their learning
15
(Bullock et al., 2013). Callaghan and others (2008) identified barriers to availability of
resources, books and electronic videos or recordings: traveling to the library,
especially whilst on placement, may not be feasible, loan periods on books are often
too short, and some students are simply not aware of the resources they can utilise.
Caldwell et al. (2007), explored the role of technology in course development, noted
limited use of electronic resources, possibly relating to inadequate IT skills or limited
access to computers in their questionnaires completed by 85 respondents.
2.5 Curriculum
The appropriate content of courses is necessary in ensuring that students are
adequately prepared, in terms of their proficiency and efficiency, for the challenges
they will face when applying knowledge and skills within health and social care
settings.
Key issues identified in the literature were a lack of agreement about what should be
included within the curriculum, gaps in student knowledge and the balance between
theory and practice.
Curriculum content
There is a notable lack of unanimity of what is and should be represented in ‘core’
curriculum (Black et al., 2010). Studies have noted the importance of teaching
professionalism (Morrison, 2008), emotional competency (Wilson & Carryer, 2008),
patient-centred approaches (Ross & Haidet, 2011) and ‘legal literacy’ (Preston-Shoot
& McKimm, 2013, 272).
Kelly (1999, taken from Lauder et al., 2008) notes a ‘hidden curriculum’ in the
development of university work; often lessons are learned by students without being
explicitly and formally outlined in the curriculum. Lessons may be taught in an
informal exchange of knowledge and ideas between the educator and the student.
The hidden curriculum has been defined as ‘the set of influences that function at the
level of organisational structure and culture including implicit rule to survive in the
institution such as customs, rituals, and taken for granted aspects’ (Lemp & Seale,
2004, p.770)
‘Mastery goals’, gaining new knowledge, and ‘performance goals’, positive feedback
on competencies, have been acknowledged by Madjar, Bachner and Kushnir (2012,
2) as effective in the monitoring of student progression in meeting targets and
increasing abilities.
Gaps in student knowledge
The literature highlighted gaps within student knowledge, not adequately addressed
by curriculum. Holland et al. (2010) observed low numerical skills from newly
qualified students in nursing and midwifery through their in-depth study of 311
participants using questionnaires, focus groups, interviews and curriculum analysis.
16
Other studies raised alarm over gaps in student understandings of disability and
mental health (Rees & Raithby, 2012), understandings of what is regarded as abuse
of elderly people (Lo, Lai & Tsi, 2010), and understandings of what constitutes
domestic violence (Beccaria et al., 2013).
The literature highlighted that continuous research is an effective way to ensure that
practice is best served and well informed (Caldwell et al., 2007). Analysis of their
questionnaire sent to a mixed group of 85 health professions, Caldwell et al. (2007)
found that 95% of students received training related to research methods during their
education, providing a source of knowledge for their practical work. Furthermore,
research is not a singular process; students should be enabled to review and
question the relevance of literature and texts within their field and perhaps make
suggestions for more applicable research, which will in turn bring a depth of
knowledge (Bientzle, Cress & Kimmerle, 2013).
Linking theory and practice
Linking theory and practice is integral to achieving student learning; the curriculum
needs to match effectively to the active learning undergone on placements. The
inter-connection should be constant but open to change (Bellinger, 2010). Milligan
(1998, cited by Girot, 2000, p.321) holds the view that both aspects of the course
complement each other – analysing the experience of nurses they found that
practical training allows the skills of students to ‘function for today’ while classroom
education enables the learning to ‘function for tomorrow’. Learning skills that have
the ability to transcend through the career of professionals is beneficial in light of the
constantly changing environment of healthcare. Woods et al.‘s (2006) study of
psychologists reported that practical performance fundamentally rests upon
knowledge of basic science mechanisms. Achieving a constructive link between
theory and practice places responsibility with education providers and practice
placement providers and the promotion of a solid relationship between both (Moriarty
et al., 2011; Holland et al., 2010).
Whilst evidence-based practice has been celebrated, time constraints have been
acknowledged as a barrier to successful implementation (Caldwell et al., 2007). It
takes a considerable amount of time for research to have practical implementation
within the healthcare setting as procedures may have to be reviewed and altered in
light of new evidence. Equally if a new way of working emerges within the
professional setting then it takes time for the validity and efficacy of the new practice
to be researched and published.
The literature highlighted the role vocational courses could play in cultivating more
professionally competent students, who are fit to practise. Grundy (2001) praises
National Vocational Qualifications (NVQs) for preparing students for practice in an
effective manner. Similarly, Girot’s literature review (2000, p.333) recognises
diploma students as having the same capability as university graduates, and in some
17
cases being ‘fitter’ to practise. Hartigan et al. (2010) demonstrated, through focus
groups of nursing students and staff, that the departure of courses away from
apprenticeship models and towards healthcare teaching within universities may have
catalysed concerns over fitness to practise as students hold fewer positions of
responsibility.
The methods of teaching also relate to the linking of theory and practice. Gallagher
(2010) endorses a ‘vertical’ approach for combining theory and practice, which is
fostered through problem-based learning and utilisation of case studies, as opposed
to more traditional methods of teaching knowledge in a separate environment from
learning practical skills. The argument for a ‘blended’ approach - mixing online and
face-to-face engagement to provide a successful interface of resources for both
students and staff - has been proposed by Rowe, Frantz and Bozalek in their
literature review (2012, p.217) for offering a link between theory and practice and
improving competency skills. Hilton and Pollard’s (2004) development of ‘skills
laboratories’ presented an innovative combination of teaching methods aimed at
improving midwifery students’ clinical abilities; although acknowledging the huge
time burdens involved in creating this learning environment.
2.5.1 Methods of teaching
Consideration and evaluation of fitness to practise also brings with it a focus on
pioneering novel methods in delivering learning to students. It is apparent within
education circles that teachers are passionate about engaging with inventive
methods (Vanier et al., 2013). There is a need for different styles of teaching to be
considered as students learn in diverse ways (Gunn, Hunter & Haas, 2012; Black et
al., 2010).
McAllister et al. (2013, p.91) promote the concept of ‘transformative learning’, with
the intention of questioning accepted norms and ideals by incorporating principles of
social justice; perspectives are altered by ‘a process by which learners call into
question accepted ideas, frames of reference, or habits of mind’. Hingley-Jones and
Mandin (2007, p.178) credit a more ‘therapeutic model’ of learning both on the
surface-level and also in-depth; arguing that a systematic method of thinking allows
for a consideration of contextual factors alongside the individual requirements of the
patient.
Problem-based learning
Problem-based learning stimulates group discussion of case-studies; students can
assess ‘cases’ within the safe setting of a classroom, allowing the chance to learn
from any mistakes (Kiersma, Plake & Darbishire, 2011). Problem-based learning
demonstrated a proven rise in the competency levels of 40 social work students in
Rees and Raithby’s questionnaire data (2012), as the learner is encouraged to
consider the individual circumstance of each situation. The benefits of education
through problem-based learning have been listed in the literature; students become
18
active learners (Nelson, Sadler & Surtees, 2005) and motivation levels rise as self-
reflective practices are encouraged (Gunn, Hunter & Haas, 2012). Role-play
situations can help prepare students for the expectations of clinical settings
(Billington, 2011); offering a link between theory and practice (Gunn, Hunter & Haas,
2012).
Virtual learning/simulation
Virtual learning and simulation have been hailed as the future of student education in
the classroom environment (Hughes, 2004). The value of simulation is the
perception that it reflects reality (Dow, 2008; Kiersma, Plake & Darbishire, 2011),
affording the opportunity for student error within a controlled environment (Nelson,
Sadler & Surtees, 2005). Simulation offers an important method to remove many
barriers to practical learning including smaller numbers of patients, and placement
opportunities and apprehension of students learning on ‘live’ patients (Bandali et al.,
2008).
Other assets of virtual education have been discussed; consideration of wider social
factors (Nelson, Sadler & Surtees, 2005), aiding critical and reflective thought
processes (Barratt, 2010; Bandali et al., 2008). Dow’s (2008) study of midwifery
literature education involved computer simulated childbirth; students found the
experience captivating, while educators saw the benefit in the ability to reproduce the
same learning practice over time. Barratt (2010) also sees the benefits videos allow
for staff to analyse their teaching styles, after conducting sixteen focus groups with
nurses. Tee & Cowen’s 2012 in-depth study of visual learning employed in a mentor
training scheme in one specific university witnessed increased knowledge and
empathy levels.
Virtual learning is not without criticism; arguments suggest that simulation can never
fully replace the role of practice placements (Bellinger, 2010). The reality of human
experience is that each situation is unique and reproductions can never create true
accuracy (Dow, 2008; Bandali et al., 2008). Furthermore, there are huge cost
associations with this learning method (Dow, 2008; Nelson, Sadler & Surtees, 2005).
Issues regarding student access to virtual settings and IT skills have also created a
barrier to development (Barratt, 2010; Nelson, Sadler & Surtees, 2005). Some
educators may view virtual learning as a threat in that it may replace the need for
them within the classroom setting (Dye, Gillon & Sales, 2009). Nelson, Sadler &
Surtees’s 2005 study of the use of computer-based virtual social work environments,
within one university setting, reported that some students fell ill with cyber-sickness.
Others caution that there is a lack of evidence of the impact of simulations on
competencies (Rowe, Frantz & Bozalek, 2012; Bandali et al., 2008).
Feedback
An important aspect of teaching is for the tutor to relay feedback, stressing positives
19
and contextualising negatives, to encourage student development through goal
setting (Findlay, 2012). Frank feedback is welcomed by students as reports have
shown this to have implications for raising confidence levels (Pal, Dixon & Faull,
2013; Wells & McLaughlin, 2014; Avis, Malik & Fraser, 2013). Girot (2000) believes
feedback entails mutual exchange of views between tutor and student. Young’s
observational study of 53 midwives, supported with individual interviews and focus
groups, found that third year students did not enjoy working without the opportunity
to ‘bounce ideas off colleagues’ (2012, 826). Delivery of opinion can be complex and
needs to be clear and direct in order to have the desired outcome (Wells &
McLaughlin, 2014). Some have suggested that training may be necessary to better
prepare tutors in this area (Findlay, 2012). Young (2012) argues that the most
effective way of organising feedback is face-to-face conversation straight after the
occurrence of events, allowing for the exchange of questions.
Some tutors, however, seek to evade feedback in person due to a fear of harming
the student’s confidence and the relationship that may be in place between the pair
(Wells & McLaughlin, 2014). Bourke et al. (2014) see technology (sending emails
and text messages) to be an honest method available to negotiate the feedback
process as it avoids any awkward situations appearing face-to-face.
Self-reflection
Self-reflection has been recognised as a valuable addition to teaching. Benefits have
included increased self-awareness (Black et al., 2010), development of reasoned
judgment and confrontation of assumed knowledge (Holmström, 2014). For students,
to reflect upon previous experience allows them to take action into the future – as
found through McAllister’s 2013 observational study of 25 mixed health professions.
Young (2012) argues that students need to reflect on their practice placements in the
safe and supportive environment of the classroom.
The most studied method of examining student self-reflection is the use of diaries
and portfolios (Fraser, 2000b; Girot, 2000; Hughes, 2004). It should be noted that the
value of self-reflection is based upon how well it is implemented and the strengths of
the methods of training and assessment (Maloney et al., 2013).
2.6 Practice Placements
Practice placements are an essential part of students’ learning, it gives them the
opportunity to demonstrate their skills and prove themselves to be fit to practise. The
influence of placement periods within course programmes has been regarded as
highly valuable (Webster et al., 2010; Holland et al., 2010). Gains in student
confidence have been noted (Webster et al., 2010) alongside growths in competence
and knowledge acquisition (Sheepway, Lincoln & McAllister, 2014; Vanier et al.,
2013).
20
The literature identified key themes relating to practical skills, improving community
engagement and issues relating to the length, timing and availability of placements.
Practical skills
Hartmann, Nadeau and Tufano’s survey of 190 occupational mental health students
(2013) observed improvement of holistic and emotional skills following practice
placements. Practical learning is seen as a process of ‘normalising’ experiences
(Conlon, 2014, 426); by contextualising every-day experiences through exposure.
The process of doing and the hands-on nature of learning have proven to be
successful in delivering successful student competencies (Gibbs & Furney, 2013); it
requires an active and social experience of ‘learning the ropes’ (Black et al., 2010,
1767). Clinical learning allows for students to prepare for future situations by
providing them with real examples to refer to (Young, 2012). In order for practice
placements to successfully improve student skills it is necessary for them to be
offered a wide range of experiences (Moriarty et al., 2011), including providing
exposure to cultural diversity and multiculturalism (Kropf, 2003). Gunn, Hunter and
Haas (2012) have also highlighted the need for a positive student attitude in
embracing all aspects of the placement.
Michau and colleagues’ 2009 study of paramedics on placement uncovered that
students were often mistreated by existing members of staff and asked to perform
duties outside of their level of competence. Black et al. (2010, p.1759) suggest that
students need to be appropriately scrutinised as ‘experience does not equal
expertise’.
Non-statutory, voluntary and community placements
Increasingly, there are arguments supporting students collaborating with the wider
community by engaging in non-statutory or voluntary placements. Bellinger (2010)
suggests that these placement environments provide diversity in experience and the
ability to increase learning. Holland et al (2010) assert that it is necessary to consider
community-based practice due to the changing demands of healthcare, which
requires a more contextualised and personal response (Holland et al., 2010).
Community-based practice in this regard refers to the health or care professional
going out and visiting the patient within their home or community setting, rather than
only in the hospital. Mathias-Williams and Thomas (2002) found that 91% of social
work students in their study anticipated working in community settings, be that
voluntary or statutory, during their future work. Green et al. (2007) argue for an
increased role of private sector placements.
Webster et al. (2010) and Paterson, Green and Maunder (2007) both examined
statutory rural placements (in Australia and South Africa respectively, where
traditional community groups may be located far from a hospital or a university).
They found that community placements of this ilk produce greater student
21
engagement, enjoyment and connection to student work, based on questionnaire
data completed by 8 respondents.
Generally, non-statutory placements are critiqued for their high costs (Webster et al.,
2010), associated transport and infrastructure problems, perceived cultural barriers
and depleted resources (Paterson, Green & Maunder, 2007).
Length and timing of practice placements
Not all literature views practice placements in a positive light. Placements are
criticised for their brevity, students feeling they would benefit from longer exposure
(Webster et al., 2010; Mathias-Williams & Thomas, 2002). There is also a desire for
placements to occur earlier in course programmes; the later they take place students
find greater difficulty to integrate their learned skills (Gallagher, 2010). Often, there
are insufficient placements available to offer to students, let alone to offer a breadth
of experience, specifically in the case of paramedic students (Michau et al., 2009).
Shortage is linked to funding availability, competition from increased student
numbers and the decrease in patient availability (Michau et al., 2009).
2.6.1 Practice educators
Practice placement educators have an important role in preparing students for the
reality of healthcare professional work. The HCPC defines a practice educator as ‘a
person who is responsible for a student’s education’, although the literature uses the
term educator and mentor interchangeably1. The literature highlighted the role of
practice educators in adopting a mentor relationship with students to help their
development, outlining both positive and negative aspects of a mentoring role. It is
acknowledged that different professions have particular definitions of ‘mentorship.’
The phrase here is used as a generic term to capture the idea of support being
provided, by an individual or individuals, to newly qualified staff.
Positive factors
Educators often take on the role of a mentor in guiding students through the
progression into the clinical working environment (Moriarty et al., 2011); mentors are
obliged to ‘bridge the gap’ between education and practice (Hughes, 2004, p.274;
Wells & McLoughlin, 2014, p.138). Support from practice educators can boost
student development and experience (Webster et al., 2010; Holland et al., 2010).
Darra (2006, p.458) discuss how mentors make the practice placement experience
‘real’ for students. Importantly, mentors must ensure that student competencies
increase; Black et al.’s (2010) longitudinal study evidenced that therapists developed
their understanding of self-awareness and communication skills with numerous
stakeholders, including patients, peers and professionals.
1 In this project the term practice educator and mentor are considered synonymous.
22
There is much literature on the relationship between mentor and mentee. Effective
mentoring takes the form of role-modelling, where students use mentor behaviour as
a prototype for their own conduct (Bellinger, 2010; Young, 2012). Students learn
skills, such as decision-making, through a simultaneous process of observing and
copying the behaviours of others (Young, 2012). Appropriate attitudes and character
are learned by a process of repetition and practice (Holmström, 2014). Andrews &
Roberts’ 2003 study of nurses on placement found that students replicate good
behaviour that is demonstrated by seniors. Ideally, the development of a relationship
between the student and educator is based upon ‘trust, patience, communication,
knowledge, empathy and respect’ (Hughes, 2004, 274). Mentors should provide a
‘safety net’ while students experience the reality of their role by consulting in
decision-making (Young, 2012, 827). Steven et al.’s 2014 study of medical students’
audio diary entries and follow up interviews found that relations between professional
doctors and students can nurture learning, despite the unequal relationship between
the two. The supervision process should be participative, the student is not passive
(Hughes, 2004). Relationships must be sensitively and constructively managed,
especially during periods of conflict (Bourke, Waite & Wright, 2014). Friendship
between the mentor and mentee can impair the judgement of supervisors (Hughes,
2004) and they may experience personal failure if the mentee is not performing to
the required standard (Wells & Mcloughlin, 2014). Findlay (2012) supports this view;
relationships cannot be a barrier to receiving necessary feedback and a balance
between comforting and supporting the student and encouragement them to step
outside of their comfort zones is essential.
Successful mentoring is fostered through the establishment of a clear framework and
guidelines to assist with the teaching role (Young, 2012; Darra, 2006). Systems must
also be scrutinised to regularly review and assess their efficacy (Hughes, 2004).
McCafferty’s report (2005, p.30) outlines five necessary aspects of supervision:
administration, teaching, helping, mediation and assessment. Additionally, Tee and
Cowen (2012) observed constructive impacts of establishing a Student Practice
Learning Advisor Service in nursing, to support the role of practice educators.
Practice educators should be aware of the need to continue mentorship and support
when students become newly-qualified as learning continues after the point of
graduation (Fraser, 2000a). Avis, Malik and Fraser (2013) demonstrated that newly-
qualified midwives actually felt more supported by mentors than they had done as
students.
Mentors are not only encountered in the practice setting, for many students there is
invariably crossover between different supervisors. Students ultimately derive
assistance from numerous sources and people (Andrews & Roberts, 2003);
throughout the duration of courses students deal with a range of people who operate
at different levels and possess dissimilar working styles (Young, 2012). Mentoring is
noted as occurring in an ad-hoc manner, as opposed to being organised via
designated personnel (Avis, Malik & Fraser, 2013).
23
Negative factors
Role-modelling is not celebrated uniformly across the literature. Patterson, Green &
Maunder (2007) have suggested that where a lack of support is in place, students
will become more pro-active and independent in their learning as a result of their
focus groups with 13 dieticians. Bourke, Waite and Wright (2014) argue that students
cannot develop independence skills if they are solely cloning and copying mentors.
The extent to which mentors succeed in guiding student education has been
questioned. Many working professionals have existing constraints on their time due
to high workloads and are unable to spare sufficient time for mentoring students
(Bourke, Waite & Wright, 2014; Hughes, 2004). There is an argument that clinical
settings are designed for professional work, not student learning (Andrews &
Roberts, 2003). Furthermore, lack of financial or monetary incentive discourages
professionals to be mentors (Bellinger, 2010). The post of mentor requires genuine
enthusiasm and commitment (Bourke, Waite & Wright, 2014). Some educators are
forced into taking on the role, even when teaching is not necessarily in their skill set
or are not adequately prepared for the role (Andrews & Roberts, 2003). Students
themselves can be an obstacle to fruitful relationships, as they may believe that
having a mentor brands them as weak (Hughes, 2004).
Wells & McLoughlin (2014) argue that effective mentors should be able to overcome
pressures and barriers. However, there is certainly a lack of uniformity in the
performance of mentors, leading to varied student experiences (Andrews & Roberts,
2003). Continuity is also impeded by shift patterns which impact on the extent to
which the student and mentor are able to meet, (Young, 2012). Poor mentors can
have long-term impressions on students (Hughes, 2004); notably bad attitudes and
disengaged work ethics (Paterson, Green & Maunder, 2007).
2.7 Assessment
Assessment offers the opportunity to evaluate whether the student graduating is
indeed fit to practise. Key themes that emerged from the literature are the definition
of competence and what issues should be considered in assessment. Assessing
students is a charged and fraught process (Girot, 2000).
Defining competence
There is an absence of accord regarding the definition of competence (Girot, 2000;
Grundy, 2001), which results in variations in the criteria used for assessment
(Moriarty et al., 2011). Hartigan et al. (2010) call for an international definition of
competence, Holland et al. (2010) request a common point of reference, and Currer
(2009) suggests that all courses need to work in line with professional bodies to draw
parallels with other institutions.
Inclusion within assessment
24
The notion of ‘professionalism’ is considered during assessment. Parker (2006)
judges professional expertise through a negative framework, comparing student
behaviour against what is deemed to be improper conduct. Arguably, unprofessional
conduct can be detected early within the course and measures can be set in place to
reduce problems (Howe et al., 2010). Fraser (2000b) argues that students should be
assessed in a holistic way - i.e. competencies should not be simplified and reduced
to lists; rather the whole professional performance of the individual’s abilities should
be analysed.
A necessary part of assessment is the ability to recognise student failure and prevent
them from graduating from the course; this is an obligation of public protection
(Currer, 2009). Fraser’s report into midwifery recounted staff testimonials that
incompetent students were being allowed to pass as a result of inconsistencies
within the assessment process, based on their in-depth and observational study of
one university (2000b). Furthermore, recent public concerns regarding the practical
abilities of newly qualified students have stressed the importance of rigorous
assessment (Young, Brooks & Norman, 2007). However, Tam, Coleman and Kam-
Wing (2012) argue that although some students may not achieve good results via
performance testing they may still possess necessary professional qualities. While
failure for some students may be a necessary option, it is important for HEI courses
to have systems of support in place for struggling students which help them to
overcome obstacles and achieve success (Gunn, Hunter & Haas, 2012). Failure then
occurs when behaviour persists despite the existence of mechanisms to support the
student (Parker, 2006).
Orr, McGrouther and McCaig’s (2014) literature review uncovered high levels of ill-
health and obesity amongst nurses. They proposed assessing professionals on their
health as they are best placed to promote healthy lifestyle ideals.
Billington (2011) supports the introduction of Objective Structured Clinical
Examination (OSCE) in assessment procedures; this method scrutinises
competencies related to technicality, critical thinking, communication and the ability
to view the patient as a whole. However, OSCE has been criticised for rewarding
students who complete a larger number of tasks, irrespective of the quality in which
they may be carried out (Woods et al., 2006). Objective assessment could be more
consistent through circulation of a handbook for assessors to consult (Fraser,
2000b).
Service users can offer valuable insights into the assessment and training of
students (Hingley-Jones & Mandin, 2007). Pal, Dixon and Faull’s 2013 study of
twelve support workers looked into the results of giving patients feedback forms to
assess the performance of students. Students were able to improve their patient-
care and communication skills, but some patients felt they were unable to answer
forms honestly due to fear of receiving poor treatment if giving negative responses.
25
Furthermore, students expressed embarrassment and feeling like a burden during
the process of giving out forms, as they do not want to bother patients during
sensitive times.
2.7.1 Student Confidence
There is a notable concern regarding student confidence levels after graduation and
registration. Fraser’s study of midwives concluded that often students express that
they have high competence levels but lack confidence in their abilities (2000a).
Similarly, Bullock et al. (2013) suggest that students feel under prepared when
graduating and Caldwell et al. (2007) reported that a third of students were not self-
assured in their capacity to perform well. Avis, Malik and Fraser (2013, p.1068)
declared that a successful student must feel ‘confident as well as competent’ after
analysis of diary entries and interviews with 35 midwifery students.
Various reasons for this lack of confidence can be identified in the literature.
Matthias-Williams and Thomas’ 2002 report into social work found that 47% of
students felt they had not received enough training or experience to develop their
skills and 88% of graduates disclosed concern about entering the workplace.
Moriarty et al. (2011) have also noted a link between limited training and decreased
confidence, on this occasion as a result of depleted resources available for personal
development. It has also been suggested that assessors can demoralise students
and impact upon confidence levels (Fraser, 2000a).
Low confidence among newly-qualified students can also occur as a result of the
transition between education and professional work environments. Moriarty et al.
(2011) discuss the dissimilarity between expected experiences and the reality that
ensues. There have been reports of students who embellish their competency skills
(Gallagher, 2010), which can result in a shock upon working. Falk and colleagues
(2013) argue that the variation between experiences lies in the different expectations
of staff. Transitioning into a role of responsibility is often difficult as students are
largely protected by staff regarding the accountability of their actions (Hartigan et al.,
2010; Avis, Malik & Fraser, 2013). Black et al. (2010, 1759-1760) suggest that the
transition period could be aided by a continuation of learning the realities of ‘actual’
practice.
Some contend that the need to assess confidence levels is unnecessary as fear
related to beginning work is a natural process for any student (Avis, Malik & Fraser,
2013). Confidence building is a process that occurs within the professional setting
and Holland et al. (2010) believe it can take up to six months for a newly-qualified
student to settle. Self-esteem and assurance occurs through developing
communication skills (Black et al., 2010; Hartigan et al., 2010). Indeed, Mathias-
Williams and Thomas’s questionnaire of 35 social work students (2002) found that
91% of students felt communication is the skill most paramount to maintaining
26
confidence, compared to decision-making, report-writing, empowering and
interviewing techniques.
2.8 Service user and carer involvement
HCPC (2003) have acknowledged the benefits associated with service user and
carer involvement in preparing students for working with patients. Following research
undertaken in 2012 (Chambers & Hickey 2012), the HCPC adopted a SET requiring
service users to be involved in the design and delivery of courses.
Service users can have a significant impact within curriculum design and leading
teaching sessions, offering reality to case-study examples and the opportunity for
reflection within a safe environment (Rees & Riathby, 2012). However, Hingley-
Jones and Mandin’s study (2007) demonstrated how students often exhibit feelings
of embarrassment when working with service users, leading to a feeling within
students that their involvement within courses is unnecessary. Hingley-Jones and
Mandin, however, have promoted the incorporation of service users within course
design and the benefits that can be gained by placing patients at the centre of
teaching.
For service user involvement to be effective there needs to be adequate training for
educators, students and service users (Forrest et al., 2000). Chambers & Hickey
(2012), in a review of the literature, identified the need for an appropriate culture,
infrastructure and resources.
2.9 Interprofessional Education (IPE)
IPE was initially piloted in the UK in St. Bartholomew’s Hospital in London, 1999
(Reeves & Freeth, 2002). Bandali et al. (2008, p.187) define IPE as learning ‘with,
from and about’; which encourages communication and settlement of disagreement
between professions. Plaudits of the interprofessional approach include the World
Health Organisation (WHO, 1988) and UK policy makers (Department of Health,
2001). Various benefits are identified in the literature as well as challenges to its
effective implementation.
A major benefit claimed of IPE is the increased awareness of the duties associated
with other health professional roles (Conlon, 2014; Ericson, Masiello & Bolinder,
2012; Ho et al., 2008; Fineberg, Wenger & Forrow, 2004) and a conscious
understanding of the health care system as a whole (Hylin et al., 2007). Caldwell et
al. (2006) have suggested that creating your own identity and professional role
occurs in a natural and productive way when defining your own role through the
context of others. Developing knowledge of the work and responsibility undertaken
by others in the clinical arena leads to a fruitful knowledge exchange process –
Preston-Shoot and McKimm (2013) note the increase in understandings, specifically
related to law, as a result of IPE. Undertaking interprofessional working at the
27
educational level crucially dispels negative attitudes and stereotypes concerning
other disciplines (Derbyshire & Machin, 2011).
Some suggest that IPE improves student preparedness to practise (Bandali, Craig &
Ziv, 2012) and that students become active learners through the process (Guile &
Grifiths, 2001: Bellinger, 2010). Greater knowledge of professionalism has been
linked to raising confidence levels amongst students (Conlon, 2014) and perceptions
of the realities of interprofessional issues that may arise (McCafferty, 2005). Falk et
al. (2013) have suggested that the learning experience becomes more valuable the
closer students work alongside other professional roles. These views are supported
by Levett-Jones et al. (2012), noting an upsurge in student commitment and
engagement throughout the learning experience. Hylin et al. (2007), in their study of
newly qualified professionals, found that, through IPE, students are notably more
independent and responsible for their own actions as they have developed
knowledge of the accountability of their professional role. Furthermore, many
transferred skills from their IPE into their current practice.
IPE encourages peer-assisted learning within the professional setting. Relationships
amongst peers, via social interactions and support networks, allow for effective
learning and confidence levels to flourish (Christiansen & Bell, 2010). Students can
benefit from their associates as they can exchange ideas without fear of judgement
from educators or assessors (Thompson & Hilton, 2011); helping to influence
decision-making (Young, 2012). Also, by developing relationships and friendships
with others students, they progress their emotional competence, which is crucial for
health practitioners. Caldwell et al. (2006) observed that 94% of newly-qualified
professionals worked within a team, acknowledging the essential nature of peer
relations.
IPE has been celebrated for its ability to conquer temporal-spatial problems, which
may otherwise inhibit learning (Reeves & Freeth, 2002). All of the students are
placed within a singular training ward, instead of spreading across the hospital
setting to allow teaching and learning to occur together. This means that students
can get an immediate response and assistance from other health professionals.
Ultimately, greater interprofessional team work is likely to improve patient care as a
result of improved communication and creating common goals (Conlon, 2014; Ho et
al., 2008; Reeves & Freeth, 2002).
It has been suggested that the benefits of IPE are more notable within the practical
setting than within the classroom (Derbyshire & Machin, 2011). However, studies of
practice placements encouraging IPE (Fineberg, Wenger & Forrow, 2004; Reeves &
Freeth, 2002) have recognised the short nature of IPE placements and the need for
courses to be longer and include a greater number of professions for students to
gain full awareness of the roles of all health professionals (Hylin et al., 2007).
28
Problems associated with Interprofessional Education
Whilst the benefits of IPE have been witnessed across the literature, it has been
criticised for a lack of commonality between standards of interprofessional learning
(Zorek & Raehl, 2012).
There is a lack of consistency between professions regarding the benefits of IPE.
Within interprofessional training it can be difficult to obtain equal representation of
students from different professions (Derbyshire & Machin, 2011; Ho et al., 2008;
Hylin et al., 2007); there may be large numbers of students for one profession and
none or only a few from another. Medical students were repeatedly mentioned as
reluctant to engage with IPE courses (Hylin et al., 2007; Reeves & Freeth, 2002).
Time-table clashes are a key barrier in bringing different student professions
together (Reeves & Freeth, 2002). Nurses repeatedly faced difficulties within IPE
training, with many students perceiving team-work tasks to be the responsibility of
nursing (Conlon, 2014; Bellinger, 2010; Reeves & Freeth, 2002) e.g. focusing on
discipline-specific roles reinforces negative attitudes that prevent
interprofessionalism from flourishing (Fineberg, Wenger & Forrow, 2004). Student
resistance to fully collaborate their work with other professionals in some cases led
to ‘turf battles’ between disciplines (Bandali et al., 2008, 184). Furthermore, some
feel that their own role becomes less significant (O’Connor, Cahill & McKay, 2012.
Goelen et al., (2006) contend that interprofessional training is expensive. The
application of IPE would demand restructuring of current hierarchies and would place
pressure upon existing staff to ensure efficacy (Ho et al., 2008; Reeves & Freeth,
2002).
Creating a climate willing to adapt to innovative IPE models is difficult when some
assert that there is limited validated evidence that interprofessionalism is a useful
endeavour (Ericson, Masiello & Bolinder, 2012; Bandali et al., 2008).
2.10 Conclusion
It is clear that there are similarities, across professional bodies and regulators, of the
definition of fitness to practise. The issues of practising ‘safely and effectively’ recur.
This is also true for the notion of the knowledge, skills, health and conduct of the
individual. An issue included in the General Medical Council (GMC)’s definition, and
not elsewhere, relates to the relationship between the practitioner and patient.
This chapter has demonstrated that many of the themes and issues in the HCPC’s
SETS also recur in the wider literature on fitness to practise. What emerges from the
literature is debate about ‘how’ these themes and issues impact upon fitness to
practise and ‘how’ they are best implemented.
The literature revealed several issues that were explored further within the data
collection events.
29
In terms of the HCPC SETS relating to programme admissions the key issues were;
Whether or not applicants should have to disclose health and previous
criminal convictions
The extent to which particular personal attributes should be considered as a
requirement for admission onto a course
.
Issues pertinent to the programme management and resources SETs were;
The role of effective management
The role played by academic staff
The extent to which service users were involved in programmes
The resources available to students.
There were four main issues that relate to the curriculum SETs;
The issue of what should be included in the curriculum
The extent to which there was IPE
The extent to which there were gaps in student knowledge and
The extent to which theory and practice were adequately linked.
This latter issue of linking theory and practice was, in turn, linked with issues which
are related to the practice placements SETS;
The extent to which newly qualified staff have adequate practical skills,
The type, timing and availability of placements and
The role of mentorship and the practice educator.
Finally, in terms of those SETs relating to assessment, the key issues were
How to define competence and
What issues should be included in assessment.
It is important to note, that although these issues did inform the data collection
events respondents were given the opportunity to raise other issues that were of
relevance to them.
Also worth noting that not all of the professions included under the HCPC’s
regulatory umbrella have been researched in this way: arts therapy, biomedical
science, chiropody, clinical science, hearing aid dispensers, operating department
practitioners, orthoptics, prosthetics and radiography. Furthermore the research that
has been undertaken has tended to be small scale and focused on single
professions.
30
Chapter 3 Methodology
3.1 Introduction
The study was undertaken using a four-stage, interdependent sequential mixed
method approach (Creswell & Clark, 2011) which includes both qualitative and
quantitative methods of data collection and analysis.
Following a literature review (stage 1), an online questionnaire survey (stage 2) was
designed and circulated. The literature review and preliminary analysis of the
questionnaire data informed the questions asked at the data collection events (stage
3), which included world cafés, focus groups and individual interviews. Finally, a
consensus workshop (stage 4) with key informants was carried out.
The project was overseen by an advisory group. Membership of this group covered a
variety of professions (social work, radiography, dietetics, speech and language
therapy, paramedics, physiotherapy) academic staff, professionals currently in
clinical practice, HCPC representatives as well as service users and carers. This
group met three times during the course of the project and reviewed all data
collection instruments and protocols, including the revised approach to data
collection. Further information is provided below.
Each stage is explained in detail in the following paragraphs.
3.2 Stage 1: Literature review and development of a matrix
A literature review was undertaken following the criteria and procedures outlined in
chapter two. The purpose was to identify the factors, mechanisms and challenges
which impact upon fitness to practise, and to explore the different models and
approaches used in previous research looking at fitness to practise issues for health
and social care professionals.
The outcomes from the literature review were organised using a matrix which
included the country where the research was carried out, data collection methods
used, the professional areas and roles included, and the findings in terms of positive
and negative factors that emerged. Strengths and limitations were also highlighted
where relevant. A version of the matrix can be seen in Appendix 1.
The literature review informed the questions included in both the online survey
(stage 2) and the data collection methods employed during the specific events (stage
3).
31
3.3 Stage 2: On-line questionnaire survey
3.3.1 Questionnaire design and implementation
Due to the diverse range of professional roles and disciplines included among the
recipients of the on-line questionnaire, two versions of the survey were needed to
reflect the expected level of awareness and knowledge of the SETs. The first group
of recipients were course directors2 and professional leads in practice (this is a term
used in health and social care to refer to an individual who has expertise skills and
knowledge of their discipline and leads a team of professionals) who would be
expected to work more regularly with the SETs and so have a greater knowledge
than other participants. They were therefore asked to consider and evaluate all of the
SETs as they are set out in HCPC documentation. Opinions on the supportive
guidance and on potential improvements were also investigated. The second group
consisted of service managers, practice educators, experienced and newly qualified
professionals. Since these professionals would not be expected to work regularly
with the SETs, a set of questions was developed that reflected key sentiments
behind the SETs. In addition, they were asked to think of any other factors that could
potentially have an impact (either positive or negative) on newly qualified
professionals’ fitness to practise.
Both versions of the questionnaire consisted of 7 sections: one each for the 5
sections of the SETs, one about the Guidance and one about other factors impacting
on fitness to practise. In addition, both respondent groups had to answer initial
demographic questions including professional role, discipline and their geographical
area. The survey used a range of different question types, including multiple choice
questions, free text boxes as well as 5 level Likert type responses.
When finishing the questionnaire a link to a further survey was provided where
respondents were asked if the research team could contact them about attending
subsequent data collection events and the final consensus workshop (stage 3 and 4
of the project). If respondents were interested in attending one or both of these
events then they could provide the researchers with their contact details. This
strategy allowed us to anonymously collect the survey answers, and simultaneously
obtain participants contact details for the following stages of the study. The complete
versions of the questionnaires can be seen in appendices 5 and 6.
Although not formally piloted due to the tight time scale of the project, both versions
of the questionnaire were discussed and reviewed by the project advisory group.
2 The HCPC refer to ‘Programme Leaders’ rather than Course Directors. However the advice of colleagues from the Faculty of Health, Social Care and Education at Kingston University and St. George’s University of London was that ‘course director’ was a more frequently used term within HEIs and so is the term used throughout this project.
32
The questionnaire was implemented and placed on-line via LimeSurvey software,
which is a highly effective method to reach a considerable number of people, being
quick, cost effective, intuitive and flexible to use.
Questionnaires were distributed in the form of a unique web link together with a
covering letter. A contact list of all the course directors providing courses which fall
under the HCPC’s regulatory umbrella was provided to the research team by the
HCPC. A total of 650 emails with an invitation to take part in the survey were sent to
course directors.
The course directors were also asked to forward an invitation letter with the
questionnaire link to one of each of the following: a professional lead in practice, a
practice educator, a service manager and an experienced professional from their
discipline.
Newly qualified professionals were contacted using a contact list, again provided by
the HCPC. They randomly selected 5000 out of approximately 15000 newly qualified
professionals among those registered with the HCPC during the previous year. The
5,000 sample was put together by taking a third of the newly qualified professionals
in each profession. The email addresses list was provided by the HCPC to the
research team following a data protection agreement. Email addresses were kept on
the computer of a member of the team, protected by a password until the completion
of the project, and then deleted.
Following the first invitation email, a follow up process was adopted. A first reminder
email was forwarded after one week of the questionnaire being sent, a second
reminder with a deadline extension after one additional week, and a third and last
reminder four weeks after. The deadline extension was deemed useful in light of a
number of answers received from respondents, showing an interest in the research
and a willingness to take part, but a difficulty related to the busy period of the year,
with exam boards and staff vacations taking place.
3.3.2 Data analysis
Following the expiry of the deadline, the data to the closed questions were exported
from LimeSurvey to an Excel spread sheet which was used to assist the quantitative
analysis of the closed questions.
Data collected through the open questions were exported to a Word document and
then manually coded using a thematic analysis approach (Braun and Clarke, 2006).
Following initial coding the codes were grouped into concepts and categories. Two
researchers from the team independently coded the qualitative data collected from
the open questions, and only at a later stage compared the results. An additional
researcher also worked on defining the concepts and the categories that emerged
from the preliminary coding. The involvement of more than one researcher, working
33
independently, on the qualitative analysis ensured credibility and trustworthiness of
the results (Quinn-Patton, 2002).
3.4 Stage 3: Data collection events
Following the survey data collection, the next stage of the research involved the
collection of further qualitative data with the aim to explore further some of the issues
that emerged from the survey. A series of events were undertaken within seven
regions across the UK, involving a cohort of HEIs and associated health and social
care organisations who provide HCPC regulated courses. Service users and carers
also took part. This stage included different types of data collection activities: world
cafés, focus groups and individual interviews.
3.4.1 Venues’ selection and participants’ recruitment
The data collection venues were chosen according to the following rationale:
I. One Higher Education Institution was identified for each of the seven
geographical areas considered, in order to ensure representation across
the UK.
II. The site offered a substantial number of courses regulated by the
HCPC.
III. The site was, relatively, easily accessible, in order to allow people from
nearby universities and towns to take part in the events.
When it was not possible to arrange a venue within an educational institution, an
alternative location was found. This happened in Scotland, where an independent
meeting room was booked in the centre of Glasgow.
A range of approaches were used to recruit people for the stage 3 events. This
became necessary in order to overcome the difficulty in recruiting a sufficient number
and variety of people. In particular, the short time period of the project initially meant
that all data collection events were scheduled for July and August; this left little time
to give notice to potential participants and was at a time when students were not
attending university and many university staff were on leave.
The following approach to recruitment was initially adopted:
I. Contacting survey respondents who expressed an interest in taking part
and who left their contact details via the link provided at the end of the
questionnaire.
II. Circulating the invitation via internal contacts within the educational
institutions hosting the events.
III. Sending out personal invitations to course directors, whose contact
details were available on the university’s website, and asking them to
cascade the invitation among academic and clinical colleagues and
students.
34
IV. Circulating the invitation to service users and carers registered on the
Centre for Public Engagement’s contact list, and asking the educational
institution hosting the events to do the same with their service users and
carers’ contact list. It was possible to reimburse travel expenses by
public transport or personal vehicle.
Subsequently, however, additional approaches were used to ensure that, if possible,
all of the professions regulated by the HCPC were included. As such we sent
personal invitations to Hearing aid dispensers, Podiatrists, Prosthetists and
Orthotists and Clinical Scientists, obtaining their contact details via university
websites. When their inclusion in the planned events was not practicable, alternative
arrangements were implemented: individual interviews in a location convenient to the
interviewee or via telephone were conducted. Two additional focus groups were also
organised, with service users and carers only, to ensure that their voice was heard.
Overall, we visited 10 different venues across 7 geographical areas. We conducted a
total of 4 world cafés, 14 focus groups and 7 individual Interviews. Also we made
additional trips to some regions to increase the number of participants.
Venues, disciplines and professional roles included in the data collection events are
shown in table one.
Table 1: Venues, disciplines and professional roles from data collection events
Venue Event Participants
No. Disciplines Professional roles
Northern
Ireland
1 World café 16 Radiography (x4)
Physiotherapy (x4)
Speech and Language
Therapy (x2)
Occupational Therapy
(x1)
Biomedical Science (x1)
Course director (x3)
Lecturer (x7)
Head of School (x1)
Experienced
professional (x2)
Service user (x2)
Carer (x1)
1 Focus
group
5 Physiotherapy
(x1)
Biomedical Science (x1)
Speech and Language
Therapy (x1)
Radiography (x2)
Course director (x1)
Lecturer (x1)
Experienced
professional (x1)
Student (x2)
4 Individual
interviews
1 Physiotherapy (x1) Service user (x1)
1 Physiotherapy (x1) Professional lead in
practice (by telephone)
(x1)
35
1 Physiotherapy (x1) Professional lead in
practice (by telephone)
(x1)
1 Dietitian (x1) Professional lead in
practice (by telephone)
(x1)
London –
University
A
3 Focus
groups
2 Non-medical prescribing
(x1)
Speech and Language
Therapy (x1)
Course director (x2)
3 Radiography (x2)
Social Work (x1)
Experienced
professional (x1)
Practice educator (x1)
Course director (x1)
4 Radiography (x3)
Art Therapy (x1)
Experienced
professional (x2)
Newly qualified
professional (x1)
Student (x1)
London –
University
B
1 World café 8 Paramedic (x3)
Physiotherapy (x1)
Course director (x1)
Experienced
professional (x4)
Service user (x3)
1 Focus
group
3 Paramedic (x2)
Course director (x1)
Experienced
professional (x1)
Service user (x1)
4 Individual
interviews
2 Social work (x2) Service manager (x2)
1 Hearing Aid Dispenser
(x1)
Course director (x1)
1 Clinical scientist (x1) Experienced
professional (x1)
Scotland –
University
A
1 World café 4 Orthoptics (x1)
Speech and Language
Therapy (x1)
Radiography (x1)
Psychology (x1)
Course director (x2)
Experienced
professional (x2)
1 Focus
group
3 Occupational Therapy
(x3)
Course director (x1)
Student (x2)
Scotland –
University
B
1 Individual
interview
1 Hearing Aid Dispenser
(x1)
Course director (x1)
36
North West
–
University
A
2 Focus
groups
4 Social work (x2)
Art Therapy (x1)
Speech and Language
Therapy (x1)
Newly qualified
professional (x2)
Practice educator (x1)
Professional lead in
practice (x1)
5 Speech and Language
Therapy (x2)
Social work (x1)
Biomedical Science (x2)
Professional lead in
practice (x2)
Newly qualified
professional (x1)
Service manager (x1)
Experienced
professional (x1)
North West
–
University
B
2 Focus
groups
9 Prosthetics (x3)
Occupational Therapy
(x3)
Biomedical science (x1)
Course director (x1)
Service user (x3)
Student (x4)
Experienced
professional (x1)
2 Speech and Language
Therapy (x1)
Service user (x1)
Newly qualified
professional (x1)
South West 2 Focus
groups
6 Psychology (x1)
Podiatry (x1)
Physiotherapy (x1)
Social work (x1)
Occupational therapy (x2)
Course director (x4)
Experienced
professional (x1)
Practice educator (x1)
2 Paramedic (x2) Experienced
professional (x1)
Lecturer (x1)
Yorkshire –
University
A
1 World café
6 Operating department
practice (x2)
Radiography (x1)
Course director (x1)
Newly qualified
professional (x1)
Experienced
professional (x1)
Service user (x3)
1 Focus
group
5 Radiography (x1)
Operating department
practice (x1)
Course director (x1)
Newly qualified
professional (x1)
Service user (x3)
Yorkshire –
University
B
2 Individual
interviews
2 Orthoptics (x1)
Operating department
practitioner (x1)
Course director (by
telephone) (x2)
Wales 1 Focus
group
2 Biomedical Science (x2) Course director (x1)
Service user (x1)
37
Table 2 shows the number of respondents by professional role.
Table 2: Professional role of respondents
Type of respondent Number
Course director 23
Experienced professional 19
Service user 18
Student 9
Lecturer 9
Newly qualified professional 7
Professional lead in practice 6
Practice educator 3
Service manager 3
Head of School 1
Carer 1
Total 101
3.4.2 Event design and implementation
The data collection events were carried out following the principles of both problem
solving and appreciative enquiry approaches. The combination of these two
methodologies allowed us to consider the emerging issues in two respects.
According to the problem solving approach, problems and weaknesses of the topics
discussed are identified, and causes with possible solutions considered. In parallel,
the appreciative enquiry principles enable a focus on the positive aspects of the
issue considered, and to engage in dialogue about “what should be” in order to foster
the positive potential of the topics under examination (Cooperrider & Srivastva,
1987).
World cafés, focus groups and interviews were audio recorded after receiving
participants’ permission, and complimented with written notes. The latter used as a
precautionary measure to protect against any machine failure, and to enable the
researcher to note non-verbal interaction and cues (Krueger & Casey, 2009).
Prior to the beginning of each data collection event, all participants provided written
consent to participate in the study.
Following the analysis of the data collected through the on-line survey, content topic
guides were developed for each type of event. The topic guides can be found in
appendices 7, 8, 9 and 10.
An objective of the research was to develop a compendium of practice examples, in
meeting the SETs, and therefore questions on effective practice were also asked.
38
The decision to use a variety of methodologies derives from an awareness of the
specific strengths and limitations of each individual method.
The World Café approach requires participants to move around tables in small
groups. Each table has an assigned topic to be discussed, a host to introduce the
questions and to facilitate the conversation (the role of the host was taken by a
member of the research team) and a scribe who was to record the key themes
emerging from the discussion and to feedback at the end of the session. This
approach is particularly appropriate when the intention is to generate dialogue,
encouraging the discussion by including various different groups or types of people,
exploring the issues in-depth, stimulating innovative thinking, as well as identifying
solutions within a large group of people (Elliot et al., 2005).
During a Focus Group participants were asked about their opinions, thoughts and
perceptions on a specific topic. Questions are asked in an informal setting, and
participants are encouraged to talk freely. This technique is particularly useful when
seeking to explore and clarify views and concepts in more detail (Marshall et al.,
1999).
Individual semi-structured interviews consist of various key questions that help to
address the areas to be explored, but also allow the interviewee to drive the
conversation in order to explore an idea or a response in more depth when needed.
The flexibility of this technique enables researchers to address and elaborate
information that are important to the participants but may not have been previously
identified by the researchers, or considered as not pertinent at a preliminary analysis
(Gill et al., 2008).
The data collection events were conducted by one or two researchers depending on
the number of participants attending. The duration of the world café events ranged
from two to three hours, all the focus groups and the interviews were between one
and two hours.
3.4.3 Data analysis
A thematic analysis approach was used to analyse the data (Braun & Clarke, 2006).
There are six phases to this approach, which need not be followed linearly. Phase
one involves the researchers familiarising themselves with the data, by listening to
data recordings and reading transcripts. Phase two involves coding. In this project
we coded line-by-line. In terms of the mechanics of the line-by-line analysis, the
advice of Corbin (1986) was followed, who suggested leaving a margin on the right
hand side of the transcribed interview to enable codes to be written next to an
incident in the data. The codes, however, tended to be substantive or conceptual
rather than descriptive and so reducing the amount of work that needed to be done
at phase three - searching for themes within the codes. The themes identified were
also compared with those that emerged from the questionnaire. Phase four involves
39
the researchers reviewing the themes to ensure that they ‘fitted’ with the data.
Phase five involves defining and naming the themes to ensure they are concise and
informative. Finally, phase six involves writing up the data, weaving the themes
together to tell an informative story and contextualising with existing literature. A
second researcher reviewed the coding to check for credibility and trustworthiness
(Quinn-Patton 2002). It is also important to note that as the data collection
progressed, the focus in data collection and analysis was on issues which had
already emerged and which required further exploration. This is referred to as
‘theoretical sampling’ (Glaser 1992).
3.5 Stage 4: Consensus Workshop
The aim of the Consensus Workshop was to discuss the findings from earlier phases
of the project and attempt to gain a consensus about any of the issues that emerged
from the data collection in stages 2 and 3.
This final event involved key stakeholders e.g. survey respondents (who had
expressed an interest) and those who took part in the data collection events across
the UK were invited. An invitation letter to service users and carers registered at the
Centre for the Public Engagement was also sent out. Service users and carers were
reimbursed their travel expenses by public transport or personal vehicle. A member
of the HCPC was also present.
In order to achieve a consensus, a modified Nominal Group Technique (NGT)
(Hickey and Chambers 2014) was used. NGT is a suitable approach when a group
of variable size is asked to focus on a problematic issue in order to generate
solutions and come to a shared decision. This approach is time efficient, needs few
financial resources, brings together experts on a particular topic and provides an
opportunity for equal input from all participants (Hickey and Chambers 2014).
The main objectives of the consensus workshop were:
To feedback the main findings from the earlier stages of data collections,
namely the on-line survey, world cafés, focus groups and individual
interviews.
To develop solutions to the issues that emerged from the research.
The duration of the consensus workshop was 3 hours. A presentation of findings was
carried out by the researchers and discussed with participants. This was followed by
two breakout sessions (two groups of 4 and 5 participants ie 9 people) in which
participants were asked to identify solutions to key questions. Each group was asked
to feedback to the wider group from which there ensued further discussion. The
session culminated in the developments of suggestions to address the issues that
emerged from the research. Researchers took on the role of mediators, to facilitate
the discussion and to ensure that all the key areas identified were covered within the
session.
40
3.6 Ethical approval
The research design and the research instruments received the ethical approval
from the Faculty Research Ethics Committee (FREC) prior to the beginning of the
data collection.
41
Chapter 4 Findings
4.1 Introduction
This chapter reports on the findings from the online survey, focus groups, world café
events and interviews.
The chapter opens with a demographic description of respondents who completed
the online survey, followed by an analysis of questionnaire responses. There then
follows an analysis of the data from open-ended questions together with qualitative
analysis of the world café, focus group and interview data. The focus groups, world
café events and one-on-one interviews tended to explore issues raised in the
questionnaires in more depth. As such the findings from the different data collection
methods have, in the main, been grouped together to avoid unnecessary duplication.
Where these findings are reported, it is made clear to the reader how the data were
obtained. Finally, there is a section describing the information generated at the
consensus workshop.
The world café, focus groups were mixed groups involving various professions and
various types of respondents, therefore we cannot relate the quotes to particular
professional groups and/or individuals.
4.2 Survey respondents
The aim of this project was to explore the views of a range of stakeholders in
considering the preparedness to practise of newly qualified health professionals
regulated by the HCPC. The questionnaire was circulated to healthcare managers,
educators, practice placement coordinators, experienced professionals and newly
qualified professionals.
Online surveys were distributed using the HCPC electronic database of registered
professionals from their 16 regulated professions. As outlined in the methodology
chapter, course directors and professional leads in practice were sent a different
questionnaire to newly qualified and experienced professionals. After circulating the
questionnaire there was initial response rate of 1195.
The following descriptions of the respondents are only those who completed the
survey in full; totaling 878 useable responses.
42
Figure 1: Professional roles from online surveys
Figure one represents the role of each person who completed the survey. The
results indicate that newly qualified professionals were the highest respondents
(73%) followed by course directors (16%). Service directors or managers were the
least represented (2%).
Figure 2: Professions represented in online surveys
16%
3% 2%
4%
2%
73%
Course director
Professional lead inpractice
Service director or manager
Supervisor for pre-registration studentlearning in practiceProfessional qualified for 2years or more
Newly qualifiedprofessional (2 years orless)
43
Clearly, some professions are more heavily represented than others. This is largely a
reflection of the size of those professions and some, such as social work, which have
a large number of courses across England. The biggest professional cohort of
respondents came from social workers in England who made up nearly a quarter of
respondents (23%)3, followed by psychologists (13%). This figure for social workers
in England is broadly comparable to the percentage of this profession on the HCPC’s
register (27%) (http://www.hcpc-uk.org/aboutregistration/theregister/stats/ - checked
on 20/10/2015). The rest of the professions each made up 9% or less of the
respondents.
However, we have aimed to strengthen the voices of these disciplines through our
interview data. There are also profession-specific themes that emerged from the
findings, which are discussed in later sections in this chapter.
Figure 3: Geographical location from online surveys
Figure three shows the geographical location of respondents. We found the
respondents to be largely equally distributed across the UK. The highest area of
respondents was in London (15%), followed by South East England (14%), North-
West England (13%) and South-West England (12%). The rest of the regions each
made up 9% or less of respondents with Northern Ireland having the smallest
proportion of respondents (2%).
3 The HCPC only regulates social workers in England.
12%
12%
5%
9%
6%
5%14%
7%
15%
9%
2%
4%South West England
North West England
East Midlands England
West Midlands England
East of England
North East England
South East England
Yorkshire and the Humber
London
Scotland
Northern Ireland
Wales
44
A note on the questionnaire data
It was noted in chapter two that two, slightly different, questionnaires were used. The
first was sent to course directors and professional leads in practice. The second was
sent to newly qualified professionals, professionals qualified for two years, pre-
registration students and service managers. The former group were asked about
each of the HCPC’s SETs (as they would work with them on a regular basis) while
the latter were asked about only some SETs, or aspects of the SETs, which would
be relevant to them. The two questionnaires can be found in appendices 5 and 6.
For ease of comparison during this chapter, the findings from both surveys are
presented within the same graphs. Both groups were asked to rank each SET (or re-
worded version) from ‘very important’, ‘important’, ‘less important’, ‘not important’
and ‘not sure’. After initial analysis of the results it was clear that the vast majority of
the respondents viewed most SETs as either ‘very important’ or ‘important’. To make
the analysis more meaningful we grouped these two rankings together in order to
highlight any discrepancies from the trend.
As course directors produced the higher response rate in the first survey and
similarly with newly qualified professionals in the second survey, for ease of
discussion in the subsequent findings we will use these titles to refer to the different
surveys.
4.3 Programme admissions
The questionnaire asked respondents to rate the importance of the SETs relating to
programme admissions (2.1-2.7). Figure four shows the combined category of ‘very
important’ and ‘important’ answers from both questionnaires.
Figure 4: Practice placement SETs considered very important/important
45
Figure four shows that both groups perceive the SETs relating to programme
admissions to be important. All but one SET is regarded as important by 80% or
more of the respondents, suggesting there is an agreement that effective admissions
criteria have an important impact upon the fitness to practise of future professionals.
4.3.1 Command of English
Both groups rated SET 2.2 as important, 99.4% of newly qualified professionals and
97.7% of course directors; ‘The admissions procedures must apply selection and
entry criteria, including evidence of a good command of reading, writing and spoken
English’. Similarly, interviews highlighted the importance of acknowledging good
levels of written and spoken English.
4.3.1.1 Defining ‘good command’ of English
Course directors revealed that their entry requirements relating to language are set
by the university. Most currently use International English Language Testing System
(IELTS) scores to determine the eligibility of applicants onto the programme – with
different courses and different universities applying different benchmarks. Some
have felt that the SETs documentation could provide better clarity on how the HCPC
determines ‘good command’ of English and what criteria may be included in this.
Command of English as a language is commonly viewed as essential for full
integration within the course and vital for becoming fully prepared and ultimately the
health professional’s ability to communicate effectively with service users in
producing high-quality care.
‘I would hate to see a student come on the programme and be struggling and not be
able to engage effectively in classes and discussion because of language.’
(Scotland - focus group)
‘We have recently been validated and one of the conditions was the IELTS… The
level that we had our standard at the HCPC weren’t happy with, so we’ve had to
change that. It was too low in their opinion; it was at 6.5 but it needed to be at 7… I
would like the SET to be more precise because my interpretation of the guidance is
that they just need good English… But this was not reflected when I had the
revalidation’ (Yorkshire - world café)
Defining command of English has been broadened by some to encompass aspects
of communication and interpersonal skills, attributes that are essential to becoming a
fully prepared health professional. Good communication is visible though behaviour
and body language, which some have suggested should be incorporated within this
SET as different cultures may communicate differently.
46
‘Not English as the language but communication and being able to talk to people that
can’t communicate well takes inter-personal skills, rather than just speaking the
language’
‘It’s about body language, it’s about expression, it’s about everything’ (North West –
focus group)
‘Some people assume that it’s a language thing but I think it’s not so much that but
instead how they communicate with you… It’s the body language and all of that’
(London – world café)
Region-specific considerations have been expressed as well. An example is that in
one HEI students are often sent to rural practice placements where varying dialects
may confuse a student’s understanding of English if they are not yet proficient.
‘Rather than English first language being a challenger maybe accents and dialects
have been a problem’ (South West – focus group)
People have also noted that the SET should not be too focused on ‘spoken English’
but programme admissions should be mindful of the ‘written English’, which is
currently considered in the SET 2.2. Written skills and communication can be very
important in the workplace.
‘You don’t get that instilled about just how important your notes are. I don’t think that
was ever mentioned to me in my training about how important it was legally’ (London
– world café)
Some respondents, however, have cautioned against setting the bar too high. It is
expected that English levels will improve throughout the duration of a course and so
restriction at the level of entry may be harsh.
‘It should be as high as we can possibly have it because of the communication
issues linked to hearing aid audiology’ (London – individual interview with course
director of hearing aid dispenser)
‘It’s not expected that at the start they will have proficiency with the language that
they will have by the end’ (Scotland - world café)
47
Not all arguments proposed a tightening of regulation regarding high levels of
English with some respondents expressing that English abilities may not directly
impede fitness to practise. While command of English may be very important,
prospective students fluent in other languages may be extremely valuable.
‘We do teach bi-lingualism and multi-lingualism and we talk about the benefits to
society and to development and all the rest of it. Having a bi-lingual workforce is part
of that.’ (Scotland - world café)
Universities are encouraged to take international students due to the high fees that
they pay.
‘There are pressures to have more international students because of the fees’
(Scotland – individual interview with course director of hearing aid dispenser)
4.3.2 Health requirements
The outlying result, within the admission SETs, is SET 2.4: ‘The admissions
procedures must apply selection and entry criteria, including compliance with any
health requirements’. While 92.8% of course directors acknowledge the importance
of this SET only 71.8% of newly qualified regarding this as very important or
important. 24.3% of newly qualified professionals saw this element of criteria as ‘less
important’ and a further 3.1% saw it as ‘not important’.
These results do not suggest that the SET should be removed or is un-important per-
se. Instead, with regards to the broader question of preparedness to practise some
have debated the extent to which health is or is not relevant.
‘Health requirements are important, but I don’t see them as important as the other
criteria’ (Questionnaire response – South West – course director for practitioner
psychology)
4.3.2.1 Variations between health admission SETs
While there has been acknowledgement of physical impairment and disability
preventing some from completing courses, others have felt that disclosure of illness
in the admissions process can be an unfair barrier to course entry.
48
‘In one area you could be completely not fit for practice and in the other area you
could be amazing… There’s no distinction between that’ (Northern Ireland – world
café)
Course directors from different regions and disciplines reported concerns about
admitting students with severe sensory impairments. There have been suggestions
for the HCPC to set clearer guidance on the topic, which is in line with their own
health policies at the point of registration. Some have felt there to be a conflict
between ‘fit for practice’ and ‘fit to complete a university course’; although these
boundaries are blurred as a large element of university education is spent in the
practical setting.
‘Obviously, if you’ve got a condition that would impede your ability then there’s no
point letting you onto the course and then them not being able to work at the end of
it’ (North West - focus group)
‘As I understand it courses have to, the law requires us to take people who are able
to complete our course. Not people, who in our judgement, will then be judged to be
fit to practise. That’s a second hoop that has to be gone through… HCPC was
saying “well you have to make decisions about your course and we will make
decisions about that student when the time comes for them applying to registration”.
So as far as I’m concerned really what we have to do is try and assess students to
complete our programme.’ (Scotland – world café)
‘We offer the opportunity for people to study for a degree, not the chance to work in
that profession. It might be incorrect for us to decide you can’t get this degree
because you can’t become a physio, there might be other reasons why people would
want to get a degree in physio… We can only make our decisions to whether the
student is fit to finish the course, with an element of practice’ (Northern Ireland –
world café)
‘Essentially it’s about their employability… We need to make sure that we’re not
wasting their time’ (Northern Ireland – world café)
Assessing health impairments at the admissions stage has difficulties.
‘I don’t think that the HCPC helps education providers at all in regards to health
checks; we are very much left to our own devices… That continues to be an issue,
the lack of clarity’ (Northern Ireland – world café)
49
Disabilities impact upon individuals in different ways, meaning that strict and
regimented policies may be unfair. Further to this, defining ‘health’ has been debated
within the results, specifically the inclusion of mental health and whether this impacts
upon a person’s fitness to practise. Specific courses may have their own reasoning
for preventing people with specific disabilities from entering onto the programme. For
example, speech and language therapy may require applicants to themselves have
good communication ability. However, examples have been highlighted of making
reasonable adjustments on courses to allow students with disabilities to become
competent practitioners. Some respondents also suggested that a student who
themselves lives with a disability may have a greater knowledge and understanding
of how best to treat patients similar to themselves.
‘One person with the same disability on paper is different from another person with
the same disability on paper’ (Scotland - world café)
‘So much about disability is contextual’ (Scotland - world café)
‘The courses are very, very demanding and we have had a number of issues with
students who have been stepping on and off courses because of mental health
issues’ (North West - focus group)
Furthermore, a person’s health may in fact change during the course, meaning that
their fitness to practise could too change. It may be unfair to prevent a prospective
student if their health may alter over time.
‘Health does fluctuate. How do you then cancel someone out of the course? It gets
very messy’ (Northern Ireland – world café)
4.3.3 Interviews
Not all courses have the same interview procedures. Some do not interview
prospective candidates, which has been criticised by others.
‘I don’t do an interview unless they are a non-traditional adult, mature, you know they
don’t actually have the entry requirements but they have life experience and they
were applying to my course… Other than that we don’t’ (Scotland – world café)
50
‘My university didn’t interview and it meant that people dropped out because they
found that they didn’t have adequate communication skills. If they would have been
interviewed them they would have found that out’ (North West – focus group)
There are perceived benefits to not interviewing all prospective students because
students are not expected to be fit for practice at entry to the programme; skills
should be developed throughout the duration of the course.
‘If it becomes too prescriptive at the point of admission then it doesn’t pay much
attention to the middle and the end result of registration and producing a student fit
for practice’ (South West – focus group)
Some believe that the HCPC should enforce interviews because otherwise there is
not pressure for courses to conduct them, which may impact on the calibre of
students.
‘We used to interview candidates and we stopped doing that because there’s no
requirement from the HCPC. I think that’s a real shame, for paramedics or any other
profession. I think that we will start interviewing again. I believe that the NMC make it
mandatory and I think we should too. I think that is coming as a result of the Mid-
Staffordshire Report’
‘Definitely some face-to-face contact, sitting down to observe the people coming on
the programme. It’s seeing how well they will fit on the programme, whether they will
be disruptive’ (South West – focus group)
4.3.4 Life experience
Some respondents discussed whether there is a place for life experience to be
considered within the admissions SETs.
‘Is there a difference between a master’s student and a BA student? Having just
recruited for 9 NQSW’s, 8 of them has a master’s degree. That says something in
itself doesn’t it? It would be interesting to do research around that, whether it’s to do
with the experience they come with before they do the course? I do think that the
younger ones on the BA course don’t have quite as much experience, not as mature.
This does filter through in terms of the way that they deal with placements and
interviews’ (London – individual interview with service manager for social work)
51
Life experience has been noted, by some, as a crucial element contributing to being
an adequately prepared professional.
‘That life experience of being able to speak to someone on an appropriate level’
(London – world café)
4.4 Programme management and resources
The questionnaire asked respondents to rate the importance of the SETs relating to
programme management and resources (3.1-3.17). Figure five shows the combined
category of ‘very important’ and ‘important’ answers from both questionnaires.
Figure 5: Programme management and resources SETs considered very
important/important.
For course directors all of the SETs relating to programme management and
resources are deemed as very important or important by 90% or more of the
respondents. For many of the SETs, however, newly qualified people were less likely
to regard them as important.
Both groups give SETs 3.5, 3.6, 3.8 and 3.9 equally high percentages for very
important and important. SETs 3.5 and 3.6 relate to the amount of staff and their
52
levels of skill and knowledge. Both 3.8 and 3.9 are concerned with the amount and
availability of student resources.
Newly qualified professionals are less likely to rate the SETs 3.17, 3.11, 3.13 and
3.15 as important for fitness to practise. 3.17 refers to service user and carer
involvement in education, 3.11 welfare facilities, 3.13 student complaints, and 3.15
mandatory attendance.
4.4.1 Students participating as service users
SET 3.14 states ‘Where students participate as service users in practical and clinical
teaching, appropriate protocols must be used to obtain their consent’. This relates to
students acting as service users during education and role-play situations. 92.9% of
course directors believed that this SET was either very important or important.
5.3% of course directors, however, believed this SET to be either less important or
not important to all. When questioned on their reasoning for low importance a
common response was that the option to sit out these valuable learning experiences
could actually negatively impact upon a student’s fitness to practise. Some people
from the professions of social work and psychology believe that students should be
expected to act as service users throughout their education, regardless of consent,
as it is integral to both courses.
‘3.14 it is simply role play. It is something that students would expect to do when
coming on a course of this nature’ (Questionnaire response – North East – course
director for social work)
‘This requirement has always seemed to me rather perverse because any student
who does not give consent freely cannot be taught, and therefore cannot stay on the
programme’ (Questionnaire response – London – course director for practitioner
psychology)
‘I just query the use of obtaining consent from students for participation as service
users. It is a basic part of social work theory that all are potentially service users.
They must participate. It is part of their training. Asking for consent seems odd’
(Questionnaire response – South East – course director for social work)
The guidance acknowledges profession-specificities by stating that ‘the level of
involvement of students will vary between programmes and profession to
profession’.
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4.4.2 Mandatory attendance
The notion of mandating and monitoring attendance has been debated and the
appropriateness of SET 3.15 contested. The SET reads ‘Throughout the course of
the programme, the education provider must have identified where attendance is
mandatory and must have associated monitoring mechanisms in place’. There was
much discussion about the lack of specificity as to ‘where’ attendance is compulsory
and whether the HCPC should offer more clarity about which elements of the course
are essential for students to attend.
Course leaders have expressed a view that the current SET does not allow them to
enforce mandatory attendance because it is not specific enough. Furthermore, some
would like regulatory backing for situations when students question mandatory
attendance.
‘There is no guidance for this from the HCPC and this means that students think that
it is not necessary to attend… We monitor through gateways. It is working but it
would be good to be better guided by the HCPC so that students can be told in
writing if they are falling short. We say that 100% attendance is mandatory in the
university but it is difficult to achieve’ (Yorkshire – individual interview with course
director for operating department practitioner)
‘I don’t want to be told what to do by the HCPC but at the same time would the
HCPC be happy if we said students don’t have to turn up to any lectures as long as
they still pass exams? I assume not. The student response will be “where does the
HCPC say that I need to be there?” and they don’t. It protects service users when we
can say that students have attended a certain amount of time at university. It’s a
difficult thing to impose because it’s not written in stone. If the HCPC set a figure
then there’s a line in the sand there… It makes it really clear to the students from day
one. I deliberately shy away from talking about attendance because I don’t have a
robust answer for students.’ (South West – focus group)
4.4.2.1 Attendance on placement vs. attendance in education
There appeared to be an agreement that all practical elements of education should
be compulsory and course leaders would follow-up lack of attendance with strict
measures. Students generally would be made to repeat practice placements if they
had not met the compulsory hours of practical experience.
‘If you miss the practical you have to re-do it. It’s felt, and this is from the students
too, that if they don’t achieve all of that time then they wouldn’t have met all of their
learning outcomes. Having a student missing two weeks would really give them a
disadvantage’ (Northern Ireland – world café)
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‘I think everyone is on the same hymn sheet when it comes to attendance at
placement’ (Scotland – world café)
Attendance within the educational environment, however, was debated. Some felt
that the ethos of university education should encourage students to be adult learners
and therefore students should not be forced to attend lectures. Some also suggested
that students can now do learning online. This online learning has enabled students
to be successful on courses when they may live a distance from campus or have
competing priorities and demands on their time.
‘The notion of mandatory attendance does not fit with HEI/Adult learning principles
100%. It is possible to learn through self-direction or directed study without being in a
lecture, class room, seminar’ (Questionnaire response – South West – course
director for operating department practitioner)
‘The practicalities of enforcing it are problematic and if we are going to be inclusive
and have widening access to students who may have a small family and they might
be working very hard at night but they aren’t always able to come in during the day
and as long as they are doing okay.’ (Scotland – world café)
One suggestion was to reword the SET, making it clear where attendance is
essential and where it is not.
‘There’s a problem with the word mandatory… Mandatory there isn’t necessarily a
consequence if you don’t do it… I think it’s important to have adequate attendance
but I don’t think that we should record attendance at lectures… I don’t see why they
should attend lectures when they can get the material elsewhere. There are certain
things, practical elements, where they should attend… So the wording should be
careful and accurate enough to allow for that. Full attendance isn’t possible and it
isn’t even desirable in certain contexts’ (Northern Ireland – focus group).
Conversely, people have suggested that simply making attendance mandatory may
not actually mean that students are actively learning.
‘You could have mandatory attendance and he’s just turned up and signed in but has
he actually learned anything? [laughter]’ (Northern Ireland – world café)
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4.4.3 Service user and carer involvement
SET 3.17 states that ‘Service users and carers must be involved in the programme’.
This SET is fairly new and was implemented from September 2014 for all
programmes regulated by the HCPC.
91.8% of course directors ranked the SET as very important/important. The results
hint that service user involvement, in some HEIs at least, was common practice
before the SET was introduced. These results, echoed in the interview data, suggest
that service user and carer involvement is closely linked to fitness to practise.
‘Social work service user involvement is really strong. Lots of involvement and input
into the programmes that means that you are getting programmes fit for purpose’
(South West – focus group)
In the survey for newly qualified professionals we asked two different questions
relating to service user involvement. One question asked the importance of service
users and carers being involved with programme development; a second asked
about the importance of service user and carer involvement in the admissions
process. For the latter, opinions have been divided, producing the lowest percentage
of respondents who regarded a SET as very important or important – 60.3%. 38%
percent of newly qualified professionals felt that this is less important or not
important.
4.4.3.1 Value of service user and carer involvement
The value of service user and carer involvement has been noted within interviews
and focus groups. Course leaders outlined the many different ways that service
users and carers can be involved in contributing to education and training, including
within the admissions process.
‘Students absolutely love seeing people with the condition coming in… One
gentleman came in and the students hung on every word that he said, they loved it’
(Northern Ireland – world café)
‘Individuals come and talk to you and then you know that you’re doing something
that is helping them and changing things. It’s the authenticity, you might read it in a
book but it’s different. It’s more realistic’ (North West – focus group)
The process is one that service users enjoy being involved in.
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‘We’re all quite vocal, as you’re discovering! Our opinions are the best! [laughter]’
(London – world café)
4.4.3.2 Where should service users be involved?
Currently the HCPC does not specify in which aspect of a programme service users
should be involved. The guidance explains that service users ‘must be able to
contribute to the programme in some way’. Where service users should be involved
within course programmes has been debated. Some have appreciated the current
open nature of the SET, which allows individual courses to make their own judgment
of where and when to involve service users.
‘We felt at the moment the SET was adequate because we don’t want it to be too
restrictive, we want to be able to use a range of methods to engage with service
users’ (Northern Ireland – world café)
Others, however, have suggested that the SET should be more specific and courses
should involve services at all levels of the programme in order for their participation
to be valued and meaningful – rather than a tick box, tokenistic, exercise and so that
they can see the full progression of the student.
‘It’s relevant but it’s only a tiny part of what we do. It just feels like a drop in the
ocean. It just feels a bit tokenistic’ (South West – focus group)
‘What incentive is there for universities to have you involved at every stage? There
isn’t one. It costs them money and time, so many courses at the moment just tick the
box that you’re involved at some point. I think that there needs to be more
incentivisation because some people only do the minimum’ (North West – focus
group)
4.4.3.3 Getting service users involved: risks, representativeness and resources
Responses also revealed problems and challenges relating to service user
involvement. Issues of resources required were raised.
‘Because of the nature of service user issues in mental health field, getting
significant involvement is a real challenge, which presents some real ethical issues.
Therefore meeting this requirement could tend towards the tokenistic’ (Questionnaire
response – South West – course director for practitioner psychology)
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Others noted that there were risks involved.
‘It’s like a can of worms. They’re people, they need managing and a certain level of
competence to do the job that you’re asking them to do’ (Yorkshire – World Café)
‘There are risk assessments of bringing someone really ill onto campus, who’s
responsible?’ (Northern Ireland – world café)
Finally there was the issue of representativeness. The paramedic below noted the
lack of a representative ‘service user’ who encounters the profession.
‘Our patients [paramedics] come from such a wide background, from minor injury to
major trauma. So we deal with such a wide range of people so one patient with one
medical condition does not mean much. Our patients and their carers often want
such different things from our service. So in that sense I just question the benefit in
many ways’ (South West – focus group)
A variation on the representativeness issue was raised by the respondent below,
who noted that some service users have an ‘axe to grind’ and are not representative
of wider service users.
‘I’ve found it to be not very valuable. I think because the people that you get tend to
have an axe to grind or something they feel very passionately about that guides
them. They tend not to look at the bigger picture and that’s what we’re looking at,
we’re not just designing a programme just for that one person. They’ve not been
representative. They’re not reliable for turning up either and actually getting them to
be involved. We’ve had patients invited on the advisory board and no one has ever
showed up.’ (Scotland – world café)
4.5 Curriculum
The questionnaire asked respondents to rate the importance of the SETs relating to
curriculum (4.1-4.9). Figure six shows the combined category of ‘very important’ and
‘important’ answers from both questionnaires.
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Figure 6: Curriculum SETs considered very important/important
Figure six shows that both groups have 90% and above of respondents rating the
curriculum SETs as very important or important aside from SET, 4.9, where 80% of
newly qualified respondents rated this as very important or important.
4.5.1 Theory and practice
SET 4.3 states that ‘Integration of theory and practice must be central to the
curriculum’. In the interviews this revealed itself as a theme that has a huge influence
on whether students are well prepared to practise.
‘Going in you can’t assess a situation appropriately without knowing particular
avenues you want to take and what options you’ve got – it’s crucial I think having a
knowledge base’ (North West – focus group)
‘You’ve got something to hook it onto, rather than just having a little ball by itself’
(North West – focus group)
However, not everyone felt that the curriculum adequately bridged the gap between
the two.
‘It was very academic and there wasn’t a lot of linking the academic to the actual
practical’ (North West – focus group)
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‘It was almost a clash between what was needed on the academic side and what you
needed to go out as a practitioner’ (North West – focus group)
‘What that’s meant is that theory and practice don’t match, so a student in their
second year may go on an adult placement but have no adult theory… Placement
providers have complained that they are having to teach theory to students as well
because they haven’t had the theory. In terms of what you do about it, to me I think
the move towards problem-based learning is the biggest strength’ (North West –
focus group)
‘At my uni there was a big focus on theory… But the main OT core skills were not a
focus’ (Questionnaire response – North East – newly qualified occupational
therapist)
4.5.2 Evidence-based practice
SET 4.7 states that ‘The delivery of the programme must encourage evidence-based
practice’. Whilst this was rated highly in questionnaire data, some respondents in the
interviews felt that, in the workplace, using only evidence based practice was not
such a simple option.
‘You have to get the balance, you have to say this is what is being done at the
moment and this is where we are heading towards. If the other hasn’t been proven
not to be working then we can’t totally throw it out either’
… ‘You can’t come out and say you can only teach what is evidence-based, you’d be
so limited! You have to acknowledge that and that it’s a work-in-progress and
everything is going to change over time’ (Northern Ireland – world café)
However, not everyone saw current practice and evidence-based practice to be in
conflict.
‘They [evidence-based and current practice] are not mutually exclusive and they rely
on each other. It is really about reflective practice for health care professions’
(London – individual interview with service manager for social work)
‘Nothing is a tablet of stone, it must be altered if it’s wrong. That’s good reflective
practice isn’t it?’ (North West – focus group)
In certain professions it is difficult to achieve evidence-based practice when
techniques may not be simply measured or quantified.
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‘There would be a disparity around evidence-based in psychology because
evidence-based is a lot around CBT because this is something that is measurable
and quantifiable. But actually if you come from a different school of thought you can’t
measure that then it’s difficult to say that you’ve got evidence-based practice’
(Northern Ireland – world café)
4.5.3 Interprofessional education
SET 4.9 is the anomaly within the curriculum data. This SET reads ‘When there is
interprofessional learning the profession-specific skills and knowledge of each
professional group must be adequately addressed’. 15.5% of newly qualified
professionals believe that this SET is less important or not important to fitness to
practise 3.5% of course directors view the SET as less or not important.
The wording of the SET is such that it does not require courses to have
interprofessional learning. Our research demonstrated that not all universities have
access to a wide range of professions and so are unable to integrate learning across
all professions. In such examples, interprofessionalism may be verbally encouraged
by lecturers but sometimes it is only in practice where the student is able to engage
with other professions.
4.5.3.1 Value in interprofessional education
A key benefit of interprofessional education, noted by some respondents, is the
greater understanding acquired of the roles of others.
‘It’s absolutely essential that the interprofessional nature is in there somewhere
because otherwise you’re in your own little world of thinking ‘I’m just an OT’, then
suddenly you go out into the placement and you’re like ‘WOW! Who are all these
other people? What’s happened here?’’ (Scotland – world café)
Another major benefit was that collaborative work contributes to better patient-
centred care.
‘It’s about understanding the patient’s journey and your point within that journey’
(Scotland – world café)
‘We don’t want patients to have to start their pathway from the beginning each time
they see a new health professional’ (Scotland – world café)
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4.5.3.2 Balancing profession specific skills and knowledge with IPE
When course lengths are not particularly long there have been suggestions that
interprofessional learning detracts from the core skills and knowledge, specific to
professions, that must be taught.
‘I think in practice this is a very difficult SET to achieve. Students are trying to
orientate to their own profession-specific skills and knowledge and it is only possible
to provide a cursory introduction to profession specific skills and knowledge when
conducting interprofessional learning’ (Questionnaire response – London – course
director for arts therapy)
‘You need to be grounded in your own profession first… But the course is so big now
and they have to cover so much that there isn’t a huge room anymore, perhaps if we
moved back to a four-year programme we could embrace it better. It’s important but
there are other priorities, your own profession is more important’ (Northern Ireland –
world café)
4.5.3.3 Making IPE happen
In its existing SET, the HCPC recognises that it may not be possible for
interprofessional learning to occur on all courses and for this reason it is not currently
a requirement within the SETs. This is complicated, however, by the SoPs that
students must meet, which state that they are required to work in an
interprofessional manner. Difficulties have been noted as a lack of all professions
willing to be involved in the process. The HCPC is exploring this through separate
research which aims to look at the scope for a more positive SET which would
require IPE to take place.
‘Without the medics being involved there is still the hierarchy, they have been a
massive barrier to the progression of interprofessional education. Until we get
everyone sat around the table it won’t be effective’ (Scotland – world café)
‘The medics facilitating were not informed about the different professions and this
lead to a very frustrating event with limited efficacy despite it being highlighted as an
integral part of learning’ (Questionnaire response – East Midlands – newly qualified
practitioner psychologist)
‘Certain professions think that they don’t need interprofessional working. I found that
strange because you always work better when you understand the role of other
people’ (Yorkshire – world café)
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Student experiences have, in some cases, found IPE unbeneficial to their learning.
‘In my opinion the sessions were completely unbeneficial, with sessions focusing on
a health perspective and considering how to address senior medical practitioners. I
came away feeling frustrated and considering my time could have been better used’
(Questionnaire response – East England – newly qualified social worker)
‘I had an issue with interprofessional learning. In my first year we got people from all
different disciplines in the classroom, we got all these different people from the
hospital who can see or probably will see the same patient. We did a project about
how to coordinate a building project. It was ridiculous! ... I just thought “why aren’t we
doing a patient pathway?”’ (Yorkshire – world café)
It has also been raised that there is an insufficient amount of interprofessional
working actually occurring within practice and so students are unable to pick up the
necessary skills.
‘I don’t get much of a sense that there is much interaction between professions
while they are on placement’ (Northern Ireland – world café)
4.6 Practice placements
Our questionnaires asked respondents to rate the importance of the SETs relating to
practice placements (5.1-5.13). Figure seven shows the combined category of ‘very
important’ and ‘important’ answers from both questionnaires.
Figure 7: Practice placement SETs considered very important/important
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All of the SETs related to practice placements are ranked as very important or
important by 90% or more by both groups of respondents.
4.6.1 Number, duration and range of placements
SET 5.2 is ranked as the highest by newly qualified professionals, with 99.4%
ranking it as very important or important. Similarly 100% of course directors believe it
to be very important/important. It is worth noting that only 3 respondents believed it
as less important/not important and 1 was not sure. Across both groups only 4
people did not see this SET as important, stressing how crucial it is for university
courses to deliver on this.
4.6.1.1 Variation between placements
The SET reads ‘The number, duration and range of practice placements must be
appropriate to support the delivery of the programme and achievement of the
learning outcomes’. Without more prescriptive guidelines there is, inevitably,
variation of practice placements between courses, between universities and between
individuals. Interview data has highlighted what some participants saw as the
negative implications of placement variation.
‘If you don’t have a broad range of placements then it can be a bit of a shock when
you come out’ (North West – focus group)
‘In regards to amount of placement I think it would be appropriate to have a minimum
percentage stated within it. You could technically put someone on placement for a 3
year course for only a week. That needs to be addressed because it is the
placements that get those clinicians up to a level where they can do the job’ (London
– world café)
‘I think there’s something needed within the SETs about that diversity of placements
and structure’ (London – world café)
‘Variation in quality of placements (and placement supervisors) was a huge factor in
my training so I think that these should be assessed more rigorously, not just the
students’ (Questionnaire response – London – newly qualified practitioner
psychologist)
There has also been a debate regarding the benefits of both a specialised approach
to placements and a generalised approach. Some have called for students to spend
a greater amount of time in one area of their professional practice so that they feel
more comfortable and confident in that area when graduating. However, others have
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stated the benefits of instead having a number of placements in different areas so
that all bases are covered, with the opportunity to then specialise when working.
‘I think that the large blocks that we did were better perhaps having a couple of
weeks here and a couple of weeks there because it allows your confidence to grow.
Every time you go to a new department perhaps you’re a little bit quiet at first then
you grow into the area and you get to know the people that you’re working with’
(Yorkshire – world café)
‘I got a good, broad range of a big hospital and various disciplines within it and
smaller hospitals where it tends to be a bit more personal with the team. So I got a
good, broad background in all of the different sides as disciplines within the hospital’
(Yorkshire – world café)
If students are not experiencing an adequate number of varied placements then they
may not have the opportunity to learn valuable practical skills. Variety between
placements has highlighted that some students gain hands-on experience, whilst
others may simply observe the practical setting.
‘Different trusts have different priorities and depending on their management will
depend on how much hands-on experience that the student will have. Some do an
awful lot more than in other places. You need to gain the trust of the trusts
[laughter]… If they’re not allowing the person that opportunity then the student is de-
skilling’ (Northern Ireland – world café)
4.6.1.2 Issues with practice placements
Current workplace demands within the NHS have restricted the availability of
placement opportunities and many universities have noted a struggle to sufficiently
provide a varied experience for all students. Many people feel that placements are
not long enough.
‘My colleagues who have attended a different university had three placements that
were 30-40 days in length, this did not enable them to gain experience of having a
caseload and the challenges the practice environment brings’ (Questionnaire
response – North West – newly qualified social worker)
Specific placement pressures have been highlighted within the debate. Within social
work a recurring issue was the need to have statutory placements during the course.
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As it stands it is not required for courses to give all students a statutory placement
and it may not be logistically feasible. However, some students who do not have any
statutory experience are unable to find employment after graduating - ultimately they
are deemed by employers as unfit to practise without this relevant experience. Some
respondents suggested that the HCPC should provide more stringent regulation to
ensure that such scenarios do not occur.
‘Every student should be given the opportunity to have a statutory placement during
the three years. By not having this they are not given the learning experience that
others may have. I was not given a statutory placement and as a consequence I left
university not feeling ready to start work. I am also finding it difficult to gain this
experience due to not being able to get a social work job because I cannot evidence
any statutory work. In this respect the university failed to prepare me for practice’
(Questionnaire response – South West - newly qualified social worker)
Orthoptic students on placements are sometimes located within high-street optician
stores and they can be located anywhere across the country, which creates
problems in how they can be monitored.
‘Quality assurance on placements is not possible, we simply can’t visit them all
because they could be located anywhere in the UK’ (Yorkshire – individual interview
with course director for orthoptics)
Also, regional logistical problems have been noted about the availability of
placements.
‘There are not enough extended practitioners practising in Scotland. That’s a big
struggle’ (Scotland – world café)
4.6.2 Role of practice educators
The HCPC uses the term ‘practice educators’ to describe the person who is
responsible for a student’s education during their period of clinical or practical
experience. Other professions and institutions may use other terms, such as ‘clinical
educator’.
Practice educators are covered in the SETs 5.7, ‘Practice placement educators must
have relevant knowledge, skills and experience’, 5.8, ‘Practice placement educators
must undertake appropriate practice placement educator training’, and 5.9, ‘Practice
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placement educators must be appropriately registered, unless other arrangements
are agreed’. All of these SETs ranked highly in the questionnaire results.
4.6.2.1 Benefits of practice educators
Practice educators have an important role in ensuring that students are prepared for
practice. Our results have highlighted the many positive effects that a good practice
educator can have.
‘Clinical educators are totally responsible for ensuring that students are fit to practise’
(Northern Ireland – individual interview with professional lead in practice for
physiotherapy)
Practice educators are important mentors and help to build confidence within
students.
‘I was closely supervised and they were there all of the time but they weren’t
standing over my shoulder. It allowed me to push a little bit further’ (Yorkshire –
world café)
4.6.2.2 How trained or qualified should practice educators be?
However, not all practice educators influence students in a positive light and
examples of poor practice have been raised as an issue that can inhibit successful
student learning. Specifically the marking of student performance has been noted as
inconsistent across practice educators.
‘Some educators/assessors mark really harsh where as others give high marks. It
doesn’t appear consistent, more just down to luck of your educator’ (Questionnaire
response – West Midlands – newly qualified physiotherapist)
‘There are discrepancies in placement marking due to placement educators
subjective views of students and the level they should be attaining which I believe is
unfair and can impact badly on student progression’ (Questionnaire response –
North West - newly qualified occupational therapist)
‘I find the quality of practice educators (placement based) incredibly variable and
their independence in grading final portfolios allows for large disparity in the grading
process… I find that as students we were massively disempowered as we were
encouraged not to complain or question poor or unprofessional practice by
placement-based practice educators… I really do think that placement educators
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need further training and monitoring’ (Questionnaire response – South East – newly
qualified social worker)
Students feeling powerless was a notion that occurred repeatedly.
‘Practice educators should be monitored extremely as they are human. All human
practice educators have capacity to oppress students. Students are in a powerless
position and structural oppression applies… I have experienced bullying and
oppressive practice educators… No support from university. In my experience it was
just business for them. No social work values were shown by university.
Disappointed’ (Questionnaire response – West Midlands – newly qualified social
worker)
‘Lack of support on placement when there is a breakdown of communication
between yourself and your educator. Instead of looking to other possible causes,
university tutors sided with my educator as they felt they were peers and blamed
myself for the issues’ (Questionnaire response – East England – newly qualified
occupational therapist)
Incentives for individuals to take up the title of a practice educator seem to have
diminished. Some have even suggested that for people to take up the role leaves
less time for practice in a period where services are already short-staffed.
‘With the changing nature of the social work and social care workforce you run the
risk of excluding some exceptional practitioners to act as practice educators’
(Questionnaire response – North West – course director for social work)
Training practice placement educators is a contested issue. The HCPC’s SET 5.8
does not specify how educators must be trained and some have still found this
difficult to achieve.
‘Less important to have actual practice placement educator training as long as the
educator is suitably experienced’ (Questionnaire response – North East –
professional lead in practice for physiotherapy)
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‘If there wasn’t a qualified mentor then there would still be a qualified member of staff
who would unofficially be there to mentor you but not be able to sign your paperwork.
They can still do a testimony that they can give to the mentor’ (Yorkshire – world
café)
4.7 Assessment
Our questionnaire asked respondents to rate the importance of the SETs relating to
assessment (6.1-6.11). Figure eight shows the combined category of ‘very important’
and ‘important’ answers from both questionnaires.
Figure 8: Assessment SETs considered very important/important
The assessment SETs were rated as very important or important by over 80% of
respondents in ensuring fitness to practise. For course directors this rises to 90%.
4.7.1 Can an assessment be ‘objective’?
SET 6.5 states ‘The measurement of student performance must be objective and
ensure fitness to practise’. While this SET was regarded as important by the vast
majority of both groups, questions have been raised regarding the appropriateness
of the word ‘objective’. It has been suggested that the notion of objectivity is in many
ways impossible to achieve as human nature will always contain elements of
subjectivity. The pursuit of an objective assessment was noted as particularly difficult
within the practical setting.
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‘Objective assessment is difficult to achieve with human factors: better to emphasise
fairness and reliability’ (Questionnaire response – East England – course director for
occupational therapy)
‘If we are looking at someone’s attitude it will be subjective’ (South West – focus
group)
‘I would question what it means that the assessment process is objective and unpick
smaller aspects of it’ (Questionnaire response – London – newly qualified
practitioner psychologist)
The data, however, also gathered suggestions for helping ensure that assessments
can be objective. Assessments are not carried out in isolation, they are made up of a
number of assessments, and there will never be one individual assessor.
Suggestions have been made for a possible re-wording of SET 6.5.
‘I think that the term “objective” here is ambiguous. Would the terms systematic and
rigorous capture it better?’ (Questionnaire response - West Midlands – course
director for physiotherapy)
‘Fair, rigorous, consistent, non-biased’
‘Uniform’
‘Maybe it needs a mash of words that have relevance’ (London – focus group)
4.7.2 Aegrotat award
SET 6.9 has raised some confusion both in the questionnaire data and also in
interviews. The SET states ‘Assessment regulations must clearly specify
requirements for an aegrotat award not to provide eligibility for admission to the
Register’. People are not always aware of the definition of ‘aegrotat’. There have
been suggestions for the HCPC to replace this word from the SETs.
‘It’s a new concept to me. I had to look it up on Wikipedia so I may not have
understood the SET properly’ (Questionnaire response – London - professional lead
in practice for arts therapy)
‘If we don’t understand it and we are in the profession then loads of people aren’t
going to understand it. They need to get rid of that word and replace it. I’ve never
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seen this word in all of my profession; maybe if you’re in a university then it is used
all of the time’ (London- individual interview with service manager for social work)
4.8 What is not covered by the SETs?
Our results highlighted key issues relating to fitness to practise that are not currently
addressed within the HCPC’s SETs.
4.8.1 Personal characteristics and attributes
Many people suggested that an element missing from the current SETs is the
mention of what is termed here ‘personal attributes and characteristics’. These are
often regarded as a vital part of being fit to practise.
‘Personal values is all about what the HCPC is about in terms of protecting the
public’ (South West – focus group)
‘It doesn’t say about good communication skills or good listening skills, something
that will actually help you be a good practitioner’ (North West – focus group)
There was mention from service users of times they have received poor treatment
due to inappropriate professional attitudes.
‘I don’t know what it is why they ignored the patients. There is an attitude that they
are the boss, so they will deal with you whenever they’re ready. Not, you’re the
consumer and I have to look after you. They’re not deferent to the patients, it’s as if
they’re doing the patient a favour and the patient should be happy. If you went into a
business or a shop, you wouldn’t be treated like that. The whole thing is the wrong
way around’ (Northern Ireland – individual interview with service user of
physiotherapy)
The benefit of professionals having desirable characteristics has been discussed as
a way of delivering patient-centred care.
‘I’ve found that they are a lot more able to treat you like a person… Most of the time
the treatment is specifically tailored for me. I want to see that extended to the
general population of patients… If you can treat everybody with privacy in mind then
some of the criticism that the NHS gets will actually decline because a lot of it is they
feel humiliated in some way not the actual treatment that they get. It’s about treating
the individual’ (London – world café)
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It has been suggested that a SET should be introduced to cover a person’s
character. Some suggested that such a SET be included as part of the assessment
SETs.
‘Personality is never, never assessed. Physical we can work with that but someone’s
personality that is so entrenched and that’s so difficult to work with. Someone can be
academically brilliant but they have a personality impediment’
‘There’s nothing in the SETs to look at that’
‘You need inter-personal understanding’ (Northern Ireland – world café)
Others have discussed personal attributes as lacking within the admissions section.
‘It [admissions] doesn’t say about good communication skills or good listening skills,
something that will actually help you be a good practitioner’ (North West – focus
group)
However, not all people see personal characteristics as essential to making a good
practitioner.
‘The bottom line for me isn’t the empathy it’s about their competence. As long as
they are a good physio and adequate with their interactions with patients. I would put
skills first every time, whether I like the guy or not’ (Yorkshire – world café)
4.8.2 Peer support
The benefits of peer support, while a student, have been noted within the survey
results and the interview data.
It has been suggested that newly qualified professionals could offer support and
guidance to students to help them be better prepared.
‘I was coming in to talk to the new students about what it’s actually like. Part of it is
with the lecturers there and then we send them off and ask the students if they’ve got
any questions. We talk about money, what jobs you can get, when you really
shouldn’t be out partying because it’s not appropriate on placement, and Facebook
that’s a huge thing… It was brilliant for us, we had a private, closed group. It might
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even be “oh what room are we in?”… Normally within 2 minutes somebody would
have answered’ (Yorkshire – world café)
Current students in elder years could also provide support to younger students.
‘I think current students mentoring new students is really good. Not so much as filling
paper work in but just there for advice’
‘If a first year student was having difficulty with anything relating to the patient,
knowing how to conduct something, then a senior student a third year would be
asked to go down to whichever area the struggling person was on and then go and
mentor the student through the procedure… You’re not a formal mentor because
you’re not qualified but you’re there with more experience to help someone who is
struggling’ (Yorkshire – world café)
4.8.3 Clinically active staff
Many participants noted the value that clinically active staff can have in creating a
richer education environment and better preparing students for practice. A member
of teaching staff who maintains their clinical skills can easily draw on real-life
examples throughout their teaching.
‘I think it would be good for the tutors to maybe go back into practice to give them
real life examples’ (North West – focus group)
‘It’s looking at it from below, looking up and thinking “you understand this because
you’ve been through this” (London – world café)
‘During my 3 year degree it was apparent how tutors did not have the opportunity to
revisit and practice social work outside the classroom arena’ (Questionnaire
response – North West – newly qualified social worker)
It is not currently specified within the SETs that education staff should be clinically
active. This may be due to the fact that it would prevent good lecturers from
teaching. It has been noted that it is problematic for all staff to be clinically active and
is not always necessary.
‘I can see the pros and cons of the debate, it gives more flavour but if your staff
aren’t clinically active then that gives them more time for scientific research which is
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also good. I think that it’s good to have a mix of both’ (Yorkshire – individual
interview with course director for orthoptics)
4.9 How aware are people of the SETs?
Within the interviews respondents were asked whether they were aware of the SETs
prior to the data collection events. We did not raise this within the survey data. Our
results revealed that course directors have a greater knowledge of the SETs than
any other group. This is to be expected as the courses for which they are
responsible have to meet the SETs.
‘In terms of programme re-approval processes then you come to live and breathe the
standards. I’ve always found them to be very clear, very explicit… We have to take
some of them maybe a wee bit further because of our professional body guidance
but I’ve never found them to be at conflict’ (Scotland – world café)
Students revealed that they are less aware of the SETs, having a better
understanding of the HCPC’s SoPs, which are profession-specific.
‘As a student you don’t look at these’
‘I think they are probably more likely to be aware of the standards of proficiency’
(Scotland – world café)
As it was mostly only course directors who were aware of the SETs, prior to events
we circulated copies and during interviews gave time and opportunity for other
participants to read the SETs in order to formulate their own opinions.
4.10 Other issues
From the data collection events a range of other issues emerged. These were the
usefulness of the SETs, the extent to which the SETs should be generic or
profession specific, what contributes to fitness to practise, the extent to which newly
qualified staff are fit to practise, managing expectations of practice and support for
newly qualified staff.
4.10.1 SETs are useful
The data indicates that the vast majority of people believe the current SETs to be
important in contributing to professionals being fit to practise.
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‘In general I find the SETs very positive although there are some places where the
guidance is needed to fully understand what the SET is trying to achieve. I’ve found
the guidance in particular very good’ (Yorkshire - individual interview with course
director for orthoptics)
‘I actually think the SETs are very good; I don’t have any major issues with them. I
was actually relieved that they were sensible most of the time… These are actually
very well worded and that allows a little bit of flexibility’ (Scotland - World Café)
‘I found it very helpful when I was designing my programme… before it was closed
down with the regulations of the time, they were too specific in some places and
were being interpreted in very different ways around that specificity and that’s how
we get into trouble. So this I had no issues with that, to me this was like a breath of
fresh air compared to the old regulations’ (Scotland – world café)
It has been suggested, however, that it is how the SETs are put into practice that is
important.
‘They’re only as good as the people putting them in place’ (Scotland – World Café)
‘It’s a personal responsibility for the student and every person that is wanting to
practise, to ensure that they meet the requirements. So you can only do so much’
(Scotland – world café)
‘It is not about the factors and issues that go beyond these listed. It is about ensuring
that the factors already stated actually happen… Of which they do not in some
cases’ (Questionnaire response – London – newly qualified social worker)
4.10.2 Generic or specific SETs?
Many respondents noted that it is a necessity for the SETs to include some degree
of flexibility as they must cover a range of professions, regions and learning
establishments.
‘You might pick up something that would work for one profession but not for another’
‘Because there’s so many involved’ (Scotland – world café)
A consequence, however, is that sometimes the SETs are perceived as ‘vague’.
‘They are generally very, very vague. That may be necessary when they are
applying to however many professions’ (North West – focus group)
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‘There’s a vagueness to it but it’s a necessary vagueness because of the breadth of
professions that it’s covering’ (London – focus group)
‘If you went any more specific you would probably be reading War and Peace’
(London – world café)
One participant also suggested that the generic SETs do not need to be as
prescriptive as they are for doctors and nurses, where more is expected.
‘It’s whether the HCPC should be more prescriptive like other regulatory bodies are.
Generally the HCPC professionals seem to cause less trouble, I’m not making
judgements on that it’s just that the volumes of complaints are so less because the
public expects a bit more for doctors and nurses’ (London – world café)
It should be noted that where problems have been discussed they are often
profession-specific. One suggestion is that the HCPC should ensure that the SETs
dovetail with the guidelines and requirements of professional bodies.
‘There needs to be a statement that these work in partnership with, or to work along
with professional body guidelines. They should inform each other almost’ (Scotland –
world café)
It has also been suggested that the SETs could be better linked to the HCPC’s SoPs
and other documentation to strengthen their relevance and guidance.
‘One of my colleagues who is an OT [Occupational Therapist] lead went to a HCPC
conference last year and she brought back a lot of little booklets. The other day I
went to where the pile of booklets was to see if there was one of these [SETs] and
there wasn’t. She said “oh no, I didn’t bring any of those, I just brought the others
[SoPs]… So that probably tells the story, that she didn’t actually see these as
relevant’ (North West – focus group)
4.11 What is ‘fit to practise’?
In questioning whether newly qualified professionals are prepared for practice,
respondents highlighted areas that made a newly qualified professional proficient
and ‘fit to practise’.
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‘What we look for is clinical reasoning, systematic problem-solving, these are the
abilities that can be carried from one placement setting to the next’ (Northern Ireland
– individual interview with professional lead in practice for physiotherapy)
‘Practice placements are the most challenging set of standards for us but I don’t
think that makes them the most useful for preparing students to be fit for practice’
(Yorkshire – individual interview with course director for orthoptics)
‘Adequate practice, good communication skills to assess the patient (which will give
good treatment), adequate theory’ (North West – focus group)
‘If you look at the six Cs then that tells you everything you need to know. You need
confidence and competence, being able to care, courage for your own convictions. If
someone can’t develop all of these, it’s not just being able to site them, then you
shouldn’t be able to pass. If you can’t sign someone off to that effect then you should
be signing someone off’ (Yorkshire – world café)
‘It’s about having a problem and thinking what do you need? What questions do I
need to ask? What is my management of that?’
‘It does come down to the speed that they can make decisions and the knowledge
and expertise that they have in different areas, the ability to think on the spot,
problem-solving capacity, ability to lead others and conflict resolution’
(London – world café)
4.11.1 Are newly qualified professionals fit to practise?
Largely the results suggested that newly qualified professionals are fit to practise.
‘They’re better prepared for changes and ensuring that they are looking for changes
in the future’ (South West – focus group)
‘Generally students are very good at interpersonal skills… In terms of communication
they’re probably stronger because we ask them to do a lot of presentations’ (North
West – focus group)
‘I was very confident in my university that I was adequately prepared for practice but
speaking to others they were not’ (North West – focus group)
However, some felt that the standard of newly qualified professionals is not good
enough.
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‘My observation would be that students are definitely not as ready for practice when
they qualify as they used to be… I think in terms of preparation for students then that
can cause quite a lot of frustration for them because they come out feeling that in
order to give a quality service you have to have endless time for each patient – life is
not like that’
‘I think that another reason why newly qualified aren’t as ready to practise is partly to
do with the way that we do placements’ (North West – focus group)
‘It’s the clinical thinking, they haven’t got that quick recognition of clinical reasoning
to deal with a busy environment. You need to give them a lot more time and support
to work through things’ (London – world café)
‘I still felt like a student, it’s very busy, you’re just thrown into the deep end… I was a
little bit overwhelmed to be honest’ (London – focus group)
4.11.2 Managing expectations of practice
Many respondents felt that the expectations of students should be managed before
graduating, so that they are aware of the role of a newly qualified professional.
Repeatedly professional staff voiced that newly qualified professionals are not
expected to know everything.
‘They should bear this in mind during their education – the registration is not seen as
the end point’ (London – individual interview with course director for hearing aid
dispenser)
‘There is a different level of thinking ‘I really, really don’t know what I’m doing’ and
‘I’m not quite sure what I’m doing but I’m hoping I’ll be able to bluff it for the first year
or so’ [laughter]’ (Scotland – world café)
‘Warning about that initial step and normalising that fear’ (North West – focus group)
‘When you go out you can never fully prepare for all of the patients you might see’
(North West – focus group)
Some newly qualified professionals have been over-confident when entering the
workplace as a result of a miss-judging their own expectations.
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‘A lot of students over pressurise themselves and in the workplace no one expects
them to know it all. Occasionally we get over confident students and we need to tell
them to pull back’ (North West – focus group)
‘I think for anyone when we lose that sense of fear there’s a danger of being over-
confident because of the nature of the job and the unknown of what the patient will
be’ (South West – focus group)
4.11.3 Supporting newly qualified professionals
Some respondents suggested that universities could better support students in their
transition from student to practitioner. Specifically students may feel anxious
approaching graduation and registration and may seek some assistance in applying
for jobs. It has been suggested that the HCPC could regulate better support during
the point of graduation and the point of starting employment, so newly-qualified
professionals do not ‘de-skill’ during this period.
‘The challenge comes in keeping up the momentum from final year into the real
world’ (Northern Ireland – individual interview with professional lead in practice for
physiotherapy)
‘I was going to just say at the end of the degree I think once we’ve submitted our
work and our final academic piece of work we were more or less dropped, so to
speak’
‘In that period there is an opportunity then because the rest of the year is so packed
with all of the academic stuff and placements but that period is free’
‘It’s a missed opportunity’ (North West – focus group)
‘Universities (and practice educators) need to focus on the transition period between
university and getting a job – preparing them. Just before the registration, certainly in
the last year’ (London – individual interview with service manager for social work)
‘We finished in August and then didn’t start ‘til mid-September so you’re already de-
skilling then’ (Yorkshire – world café)
As part of this process it has been suggested that newly qualified professionals
should have a period of transition when they first enter into the workplace.
References were made to ‘mentorship’, ‘preceptorship’ and ‘continued professional
development’.
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‘All newly qualified staff should undergo some form of mentoring in their first year of
practice, it’s like any transition and they will need support for it’ (Yorkshire –
individual interview with course director for orthoptics)
‘Something like a preceptorship – someone’s got your back while you’re still learning’
(Yorkshire – world café)
‘One issue I personally faced was the transition from student to newly qualified. I
wasn’t treated as a newly qualified once I was 2 months into my practice. I had 10
child protection cases and 11 child in need cases with 3 months of being newly
qualified. This burnt me out… Newly qualified need to shadow qualified workers with
no case load for at least 2 months. Then slowly introduce manageable cases’
(Questionnaire response – North West – newly qualified social worker)
‘We’ve designed a preceptorship programme. I want it to be the standard one for
clinical scientists.’ (London – individual interview with clinical scientist)
These systems are recognised as beneficial for newly qualified staff to continue their
learning in a supported way before becoming fully autonomous and responsible.
There were, however, individuals with reservations about the use of some terms.
‘I personally think that the preceptorship of 1 year is too long when students are
coming straight out of a course. We need to think of it as more of a transition than a
preceptorship’ (Yorkshire – individual interview with course director for operating
department practitioner)
4.12 Summary of findings
The survey suggested that the current SETs were regarded as important by the
majority of respondents. However, open questions and data collection events did
though reveal many suggestions for enhancing some SETs and some questions
about how to implement the SETs. It was not possible to cover all of these issues in
the consensus workshop and an assessment was made about what were the key
issues. A key issue to emerge was that of the ‘theory practice gap.’ Two important
components of this were the placement experience, in particular the variety and
quality of the experience, and the role played by the practice educator. Another key
issue was that of the ‘personal characteristics’ of a student and qualified
professional. This notion of ‘personal characteristics’ can be hard to define,
encompassing a variety of issues from interpersonal skills through to the extent to
which an individual is ‘caring and compassionate.’ However defined it seems to be
crucial to providing patient centred care and was an attribute that should be
demonstrated by all practitioners. Finally, there were some respondents who were
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concerned about SET 6.5 “The measurement of student performance must be
objective and ensure fitness to practice”; in particular they were concerned about
how objectivity could be achieved.
4.13 Consensus workshop
The final stage of data collection was a consensus workshop focusing on the
evidence collected via the surveys, focus groups, world cafes and interviews. The
aim of the day was not necessarily to collect new opinions but to discuss existing
views in a framed debate and to develop solutions to the issues that emerged.
Following a presentation outlining the background to the research and the key
findings that had emerged, the participants were divided into two breakout groups to
discuss four key issues:
1. Variety and quality of placements
2. Role of the practice educators
3. Can assessments ever be ‘objective’?
4. Importance of personal characteristics
Participants in the workshop were a mix of service users, academic staff,
professional leads in practice, and HCPC staff. The group discussions were
facilitated by staff involved in the research project (see Appendix 11 for full results).
4.13.1 Group discussion
The two groups agreed that there was no need to introduce new SETs to address
any of the issues. Generally the groups were satisfied with the SETs and felt that
they adequately prepared newly qualified professionals to practise. The participants
felt that the discussion points could be captured by existing SETs by providing links
to HCPC guidance, professional body recommendations and providing good practice
examples.
4.13.2 Variety and quality of placements
The groups concluded that SET 5.2 could be better linked to SETs 4.1, 4.2 and 4.3
from the curriculum section. Ensuring that the learning outcomes were better linked
to the curriculum could ensure better integration between theory and practice. This
could help to reduce the variation between different placements and ensure better
learning outcomes. It was acknowledged that different professions have different
‘core’ curriculums which are advised by their individual professional bodies. If the
HCPC were to work alongside professional body guidance then they could produce
more specific regulation on what the ‘number, duration and range’ of placements
would look like for each profession.
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4.13.3 The role of the practice educators
The groups concluded that the definition of ‘practice educator’ needs to be reviewed.
It was agreed that due to staffing pressures it would be logistically difficult to set out
specific time allocations for mentors. Also, students receive guidance from a whole
range of people in the practical setting. For these reasons the definition of practice
educator has become blurred. Both groups believed that the HCPC could provide
better guidance on how to be a good mentor and could supplement this with good
practice examples.
4.13.4 Can assessments ever be ‘objective’?
There was debate between the groups on this issue and they did not reach an
agreement. While one group felt that the word ‘objective’ should be removed and
replaced, the other felt that it was essential for it to remain in the SET. The second
group felt that there are ways of managing the assessment process to reduce
subjectivity: measuring the student on numerous occasions, using learning outcomes
and having a number of assessors. The first group felt that true objectivity is not
possible and the word should be replaced in the SET with ‘holistic’, so that the whole
of the student is judged rather than a specific set of competencies. Both agreed that
assessors need better guidance on how to achieve this SET effectively.
4.13.5 Importance of personal characteristics
The groups concluded that there was no need for this to become a new SET and
that it could be included within SETs 4.2 and 6.3. Participants felt that professional
qualities will differ from profession to profession and introducing a new SET may be
difficult. They did agree, however, that communication and interpersonal skills should
apply to all health and care professionals. Therefore, they felt that there was scope
for these elements to be included within the current SETs and/or guidance. It was
acknowledged that these ‘soft skills’ are addressed within the profession-specific
SoPs, and so it was suggested that a better link between the two documents may
address this issue, e.g. a URL linking the two documents.
For all of the issues raised within the consensus workshop the participants agreed
that these issues would not be resolved by creating new SETs. This finding concurs
with previous data that respondents are satisfied with the current SETs. The
consensus workshop, however, did suggest that the SETs need to be better linked to
the other guidance provided by the HCPC, and also better linked to suggestions from
professional bodies in order to help address specific problems. Where people may
struggle with visualising certain SETs it was repeatedly mentioned by participants
that good practice examples would ‘bring the SETs to life’.
4.14 Conclusion
The findings from this project echoes similar themes to that identified within the
literature regarding what elements are relevant in producing a professional fit to
practise. Specifically the role of the SETs in contributing to the preparation of newly
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qualified professionals has been explored within this research. The positive aspects
related to the SETs and issues for their implementation have been discussed.
The data suggests that the vast majority of respondents see the SETs as either very
important or important in ensuring fitness to practise. Course directors are more
likely to rate the SETs as very important or important. For every SET 80% of course
directors ranked it as either important or not important. Newly qualified professionals
are more likely to rate SETs lower. Although 80% or more of newly qualified
professionals also saw all SETs - beside six (2.4, 3.11, 3.11, 3.13, 3.15, 3.17) – as
either very important or important. These results suggest that the SETs are crucial
for determining fitness to practise.
Both course directors and newly qualified professionals saw ‘practice placements’ as
the most important section relating to fitness to practise, with all being ranked by
90% as very important or important. Specifically the number, duration and range of
placements and the role of practice educators were highlighted as determining the
success of individual professionals.
Programme management and resources was the SET that produced the lowest
percentages of very important or important from newly qualified professionals.
Specifically SET 3.17 relating to service users and carers raised issues for how it
can be appropriately implemented. Only 60% of newly qualified professionals
believed that involving service users and carers within the admissions process was
very important or important. However, 84% of newly qualified professionals saw
involving service users and carers within teaching, assessment and evaluation as
very important or important. There appears to be a lack of communicated value in
the benefits of service user and carer involvement.
Where issues were raised regarding the SETs they were usually profession-specific.
The results highlighted awareness that the SETs covered 16 professions and it was
therefore essential for them to remain open. The perceived ‘vague’ nature of the
SETs was deemed as essential to allow each profession the capacity to tailor the
SETs specifically to their course. However this then makes the SETs general and
open to critique of being unable to provide adequate guidance. The findings
suggested that this could be overcome by greater collaboration between the HCPC
and professional bodies. There appears to be general support for the current SETs,
which could be supported and supplemented by better links and providing good
practice examples.
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Chapter 5 Discussion and Recommendations
5.1 Introduction
The HCPC reviews its SETs on a regular basis. The project presented here is one of
three strands of work reviewing the SETs and supporting guidance. A second strand
is research into IPE while a third is internal HCPC research and stakeholder
engagement activities to gather views on the SETs.
This project explored the role played by the SETs and supporting guidance in
ensuring that education providers have the structures and systems in place to
prepare students to be fit to practise at entry to the Register. These findings should
be considered together with findings from the other strands of work.
5.2 SETs are regarded as important in terms of ensuring fitness to practise of
newly qualified staff
All but six of the SETs were ranked as either very important or important by 80% or
more of the questionnaire respondents. Just six SETs (2.4, 3.11, 3.11, 3.13, 3.15,
3.17) were rated as important or very important by less than 80% of newly qualified
professionals. Newly qualified professionals in particular were less likely to view the
group of SETs related to programme management and resources as important or
very important.
The results show that course directors were generally more inclined to view the
SETs as very important or important compared to newly qualified professionals. This
may be because course directors have more exposure to the SETs throughout the
process of course approval and design.
Both course directors and newly qualified professionals saw the group of SETs
relating to practice placements as important. This was echoed within the interview
data, with many believing that the success of students feeling adequately prepared
was largely dependent upon their experiences within placement and their ability to
integrate theory and practice. These results are consistent with the literature
highlighting the importance of practice placements (Holland et al., 2010). Placements
can improve students’ knowledge, skills and competence levels (Sheepway, Lincoln
& McAllister, 2014; Vanier et al., 2013) but also their confidence (Webster et al.,
2010)
5.3 The HCPC’s definition of fitness to practise is consistent with that of other
professional bodies and regulators
The issues of practising ‘safely and effectively’ recur in various definitions of fitness
to practise. Knowledge, skills, health and the conduct of the individual are also
frequently mentioned. There is one issue, included in the GMC’s definition, and not
elsewhere, that relates to the relationship between the practitioner and patient. Some
might suggest that this notion of a relationship between the practitioner and patient is
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implicit in the phrasing ‘safely and effectively’. The data suggested that respondents
would prefer a more explicit statement.
This issue is worth mentioning here given that a theme which emerged from the
research findings, often from service users, was that some health and social care
professionals are unable to relate to service users in an appropriate way.
This is clearly a complex and multi-faceted issue, with some respondents suggesting
this is due to the character of the professional making them unsuitable for a given
profession while for others it was about the behaviour of the professional and how
they treated service users. There are also a range of words, not always consistent,
which are used to describe these ‘softer’ activities such as ‘caring and
compassionate’. The literature highlighted considerations of sensitivity (McAllister et
al., 2013), maturity, initiative and communication skills (Fraser, 2000a). It has been
suggested that these attributes could be described as ‘emotional intelligence’. Laird
et al (2015) refer to person-centred care including knowing the service user, working
with their values and beliefs as well as developing positive relationships. This
touches on a point discussed at some of the data collection events about the extent
to which such attributes are innate or can be taught.
Specifically, the inclusion of personal characteristics and attributes within the SETs is
a highly important debate that should be considered by the HCPC. Many
respondents believed the character of a person to be highly important in determining
the fitness to practise of a newly qualified individual, and that this was not covered
adequately in the SETs. The SETs do mention ‘values and ethics’ and ‘professional
behaviour’ but many respondents did not think this quite captured the notion of
‘caring’ or ‘emotional intelligence’. The SoPs do address this issue, and a
recommendation (see Recommendation 4) is to make stronger links between the
SET and SoP documents.
However, the HCPC may want to consider whether this issue of the relationship
between the professional and the service user should be included in their definition
of fitness to practise.
Recommendation 1: The HCPC should consider adding a reference to the
development of relationships with service users to their definition of fitness to
practice
Recommendation 2: The HCPC should consider making an explicit mention of ‘soft
skills’ within current SETs
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5.4 Generic and flexible SETs vs specific and prescriptive SETs
A decision was made to adopt generic (rather than profession-specific) SETs which
covered all 16 professions rather than a specific group of SETs for each profession.
Some SETs were criticised for being ‘vague’. However, it was recognised by many
respondents that if the SETS are to cover 16 professions then this necessitates them
not being too prescriptive, allowing for flexibility amongst the different professions.
Furthermore, some respondents pointed out that it was the SoPs which were
profession specific and that it was important the SETs were not viewed in isolation
but rather as part of a range of standards.
Professional bodies also provide their individual professions with guidance on how to
manage certain aspects of their courses in relation to fitness to practise. Course
directors have found the input of professional bodies to be highly important and have
designed their courses by mapping HCPC regulations against the recommendations
of professional bodies. The exercise of joining both of them could be eased if there
were greater collaboration between the organisations. The SETs document does
make some links to the SoPs and to professional body curriculum frameworks, for
example 4.1 and 4.2; but there were suggestions these links could be stronger.
Similarly, SET 4.5 does make a link to the HCPC’s standards of conduct,
performance and ethics; but again there could be a stronger link so that newly
qualified professionals are aware of appropriate behaviours. The HCPC could
acknowledge that professional bodies are the place to seek specific professional
guidance.
Recommendation 3: The HCPC’s SETs and guidance should include stronger links
to SoPs and HCPC’s standards of conduct, performance and ethics, and also the
standards and requirements of professional bodies.
Suggestions include:
URL link
Explicit link within the introduction to the SoPs and standards of conduct,
performance and ethics, and professional body guidance
5.5 How SETs are implemented
Although the SETs are regarded as important, this does not mean that they are
devoid of issues. There is concern about ‘how’ some of these SETs are
implemented. It has been suggested that SETs remain sufficiently broad and flexible
to appropriately reflect each of the 16 professions. A consequence of generic SETs
sometimes HEIs would like information on how to adhere to or implement the SETs.
The guidance, for the same reasons, also has to be broad.
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5.5.1 Command of English
There was some debate about the ambiguity of the phrase ‘good command’ (of
English) within SET 2.2. The guidance expands on this SET outlining that entry
criteria ‘should be appropriate to the level and content of the programme’ and
acknowledges the communication aspects related to this SET by referring to the
SoPs that should be met by each student. Yet ultimately it is ‘for you to decide’. The
level of English did not arise within the literature that we surveyed but was a
pertinent issue within our results.
Our results show that language is highly regarded within health and care
professions, as it is the means by which effective communication can take place
between the practitioner and the service user. Arguably it is more important for some
disciplines (e.g. speech and language therapy) than others and in areas when
professionals are interacting with patients who have learning disabilities. The
guidance states that students must be able to fully engage with the course from the
outset. Given that students could possibly be sent onto placement within their first
semester patient care should not be compromised by inadequate levels of English.
There have been concerns from the General Medical Council (GMC) and Royal
College of General Practitioners about doctors without a sufficient command of the
English language (http://www.theguardian.com/society/2015/oct/28/two-eu-doctors-
disciplined-for-inadequate-english).
Although no data were collected on this issue, it is acknowledged that course
directors are often under pressure to accept international students, as they generate
income for universities. This pressure may lead to some course directors accepting
students with poor command of English. With regulatory backing on a minimum level
of proficiency from the HCPC, course directors would be in a stronger position to
resist financial pressures.
The HCPC, like other regulators, do require people trained in other countries, and
seeking registration to practice in the UK, to acquire a particular IELTS score (8 for
speech and language therapists and 7 for all other professions).
The GMC now require that people, from Europe and elsewhere, wishing to be
employed as doctors in the UK get a score of at least 7.0 in each testing area of the
IELST (speaking, listening, reading and writing), and an overall score of 7.5
(http://www.gmcuk.org/doctors/registration_applications/13680.asp).
A similar requirement has been specified by the NMC, stating an overall score of 7 is
required for all non-EU trained applicants to the nurses or midwives part of the
register
(https://www.healthcareers.nhs.uk/i-am/outside-uk/information-overseas-nurses).
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However, the scores referred to above apply to people who are already qualified via
courses undertaken overseas. Some respondents in this project suggested that it
would be helpful if the HCPC could set a minimum score of IELTS that all health and
care professionals should obtain before being allowed entry onto a course. Indeed,
some respondents said that the HCPC had provided them with guidance on this
issue, suggesting that a score of 6.5 was appropriate. It seems that there is some
confusion about the guidance currently provided by the HCPC. Setting a minimum
standard, prior to entry to the course, would provide a sense of uniformity across
institutions and reduce variation within patient experiences. The minimum level could
reflect the opportunity for language skills to develop whilst the student is on the
course.
Recommendation 4: The HCPC to consider providing a minimal IELTS score for
students, whose first language is not English, seeking a place on HCPC regulated
courses.
5.5.2 Health requirements
Debates on the issue of health are laden with complexities and as such an
amendment to the SET 2.4 would not be advised. It is important to note that the
HCPC has recently provided guidance on this topic, ensuring their responsibility to
remain fair to registrants with disabilities (HCPC, 2015). The report entitled ‘Health,
disability and becoming a health and care professional’ advises students and all
those involved with healthcare education – specifically navigating the complex nature
of health requirements during the process of admissions. Prospective healthcare
students can make use of the document to guide their decision as to whether their
own health is a barrier to fitness to practise or not. It would be valuable for the HCPC
to make a clear link to this document within the SETs so that people are aware of the
resource and the support it offers.
During project interviews most debates focused around the extent to which physical
disabilities could prevent a practitioner being able and fit to practise. On a number of
occasions the mental health of an individual was raised as a potential barrier to full
engagement with courses. Clearly, the HCPC would not want to be discriminatory or
deter potentially excellent candidates from applying to courses. Indeed, the HCPC
states that courses should not be discriminative within their admissions process.
Stanley et al. (2011) have studied the element of personal disclosure of health and
found that some people are less likely to disclose mental health issues due to fear of
exclusion and stigma. It could be suggested that having lived experience of mental
illness might strengthen an individual’s ability to engage and relate to service users.
That said the SET, guidance and the report mentioned above do not make explicit
mention of mental health/mental illness - the focus is on physical health. It is
essential for mental health to be acknowledged within HCPC documentation and
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subsequently university admissions so that students can have access to necessary
support systems.
Recommendation 5: The HCPC to make a clear link, in their SETs and guidance, to
the document ‘Health, disability and becoming a health and care professional’
Recommendation 6: The HCPC to make explicit mention of ‘mental health’ within the
SETs or guidance
5.5.3 Service user and carer involvement
SET 3.17 is related to the involvement of service users. The problems around this
SET are exacerbated because it is a new SET and some institutions do not have
much experience in ‘how to do it’. The results have shown that some struggle to
involve service users effectively. Some have felt that the current SET is too
demanding in that service users ‘must’ be involved given that students are
interacting with patients throughout their practice placement experience. Chambers
and Hickey (2012) have noted the importance of culture, processes and resources.
However, our results have demonstrated that other institutions have succeeded in
involving service users throughout courses. Service users and students alike have
enjoyed high levels of satisfaction from the process. Clear benefits can be drawn
from service user involvement in delivering education. Service users can get a
feeling of empowerment (Frisby 2001, Masters et al 2002, Happell and Roper 2003,
Rees et al 2007, Skinner 2010) and a sense of altruism (Brown and Macintosh 2006,
Haffling and Hakansson 2008). The involvement of service users can help challenge
student assumptions and stereotyping (Dogra et al. 2008, Rush 2008, Anghel and
Ramon 2009, Branfield 2009, Schneebeli et al. 2010, Thomson and Hilton 2011),
and contribute towards a more positive view of service users (Lathlean et al. 2006,
Simpson et al 2008). Rees & Raithby (2012) have noted how service users add a
sense of reality to the education.
5.5.4 Interprofessional education
The requirement for more effective collaboration between professions has been
noted by the introduction of The Health and Social Care Act (2012), and the National
Collaboration for Integrated Care and Support (2013) and various benefits of IPE
have been articulated in chapter two. However, for some there have been difficulties
implementing interprofessional learning within the curriculum. IPE is crucial to learn
with and about the roles of others, in order to understand the individual’s own
professional role (Conlon, 2014; Ericson, Masiello & Bolinder, 2012; Ho et al., 2008;
Fineberg, Wenger & Forrow, 2004). The benefits of this can be seen directly with
improved patient-centred care through creating common goals (Conlon, 2014; Ho et
89
al., 2008; Reeves & Freeth, 2002). This is echoed by the views of service users from
our results in that collaboration between health professionals can stop the ‘revolving
door’ process.
Some believe that interprofessional education takes place within practice placements
therefore there is no need for it to be taught within the education setting. However,
our data has suggested that interprofessional collaboration is not always evidenced
within current practice placements. There have been logistical issues for some
institutions in finding space within course timetables to facilitate interprofessional
teaching. Some are restricted by the small number of other health professions that
are taught within their universities. The literature has also discussed the difficulties of
obtaining equal representation across professions (Derbyshire & Machin, 2011; Ho
et al., 2008; Hylin et al., 2007). This has led to a number of examples of taught
modules on interprofessionalism, not adding much value to the student’s experience
and becoming more of a tick box exercise to fulfil this SET.
5.5.5 Management of practice placements
The management of practice placements is a key issue. Many students and newly
qualified professionals have commented on variety of the placement experience.
Placements are integral in developing student confidence and preparation. These
variations exist between regions, institutions, organisations, and practice educators.
Working with professional bodies (sharing their standards and regulations) and
providing good practice examples could go some way to alleviating these variations.
Results specifically highlighted the varying lengths of placements. The more
exposure students gain on placements the more benefits they will acquire (Mathias-
Williams & Thomas, 2002). Our results have shown that many placements are
regarded as too short, meaning that students do not have long enough to settle and
feel comfortable within a setting before they leave their placements. It should be
noted that the length of practice placements is dependent on the nature of the
course and the availability of placements within that region.
An issue also arose relating to the matching of theory and practice between the
taught curriculum and what is learned on placement. Gallagher (2010) found that
students struggle with their ability to integrate their learned skills within the practical
setting. Due to the challenges of gaining placement opportunities it is not possible for
course directors to map the theoretical learning from the classroom directly to the
practical placement elements. Michau et al. (2009) have studied the reasons for
shortages of placements, linked to funding, increased student numbers and
decreasing patient availability. This has meant that students have struggled to
consolidate their learning of the theory with lived examples. Our results have shown
that some students are having the same practical experience across different
placements, rather than being exposed to new areas of practice. This can limit
practical skills developing and lead to some student feeling unprepared for practice.
90
The role of practice educators is crucial for the successfully preparing students for
practice. Educators can take on the role of a ‘mentor’ and can bridge the gap
between education and practice (Hughes, 2004; Wells & McLoughlin, 2014). Their
role is to guide students and develop their practical competencies. It has been noted
by Black et al. (2010) that student self-awareness and communication skills are
developed strongly through mentorship. Our results have highlighted both positive
and negative examples of practice educator behaviours, which can have lasting
impressions on the student. It has been recognised within the literature that practice
educators may struggle within their role as they already face numerous time
pressures and high workloads (Bourke, Waite & Wright, 2014; Hughes, 2004). This
can have an impact on the amount of time educators are available to support and
facilitate student learning.
The HCPC require practice educators to be qualified, trained and registered within
the SETs. However, the lack of uniformity across mentors’ activity and behaviour
raised questions within the project regarding variability. A specific issue arose
surrounding the definition of a ‘practice educator’. Some take on this role after two
years’ experience as a qualified professional, sometimes our respondents claimed
with little training. A standardised level of training for all HCPC practice educators
could create a more consistent student experience. This could include reviewing
practice educator training across all professions. It has been suggested that
dedicated time be included within practice educator’s job descriptions in order to truly
develop a relationship with students.
Recommendation 7: The HCPC to review practice educator training with a view to
developing broad principles about the role of practice educators
5.5.6 Addressing the ‘how’ issue
Project participants would welcome advice on ‘how’ to implement the SETs to a high
standard and suggested the sharing of practice examples – these could inform a
future publication (see Appendix 12). This could be a publication available on-line of
practice examples, where specific institutions have addressed different SETs
effectively in the form of a ‘how to’. The intention of a valuable publication would be
to identify possible pathways for HEIs through the SETs. It would be up to individual
institutions to determine the extent to which they adopt or adapt the examples.
Recommendation 8: The HCPC to consider the development of a ‘how to’ practice
guide to complement the SETs and the guidance
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5.6 Suggestions to reword SETs
SET 6.5
Throughout the project there was considerable debate surrounding the use of the
word ‘objective’ within SET 6.5, ‘the measurement of student performance must be
objective’. Objective assessment has been encouraged within the literature, with
calls for universities to adopt Objective Structured Clinical Examination (OSCE) in
assessment procedures. This method considers technicality, critical thinking,
communication and the ability to assess patients (Billington, 2011).
Many respondents called into question whether any form of assessment can ever be
truly objective and have suggested for the wording to be changed in this SET.
Participants have claimed that there will always be an element of subjectivity,
specifically within the practical setting. However, others have claimed that objectivity
should be sought for at all times to ensure fairness. Proponents believe there are
methods to ensure objectivity: by following learning outcomes, completing numerous
assessments, and by consulting the opinions of others. This SET has consequences
for the experience of students; some have felt that assessments have been biased
and unfair. Fraser (2000b) has suggested that a holistic method of assessment be
used, so that the whole of student performance is considered rather than a specific
list of competencies measured in isolation.
Both the words ‘must’ and ‘objective’ have been considered for possible alteration.
Suggestions have been made to include other terminology to supplement the word
objective. Considering the debate from our project findings the notion of assessment
objectivity was considered within discussions at the consensus workshop. However,
the group were unable to reach a collective decision surrounding the inclusion of the
word ‘objective’. As a result they offered three different suggestions to alter SET 6.5,
listed below. We are aware that not all of the suggestions may be implemented due
to contradictions, but feel that this is something for HCPC to consider.
Recommendation 9: Re-word the SET 6.5. Suggestions are:
Replace ‘must’ with ‘should aim to be’
o ‘The measurement of student performance should aim to be
objective and ensure fitness to practise’
Replace ‘objective’ with ‘fair’, ‘rigorous’, or ‘uniform’
o ‘The measurement of student performance must be
fair/rigorous/uniform and ensure fitness to practise’
Keep ‘objective’ but include ‘fair’, ‘rigorous’ and ‘uniform’ too
o ‘The measurement of student performance must be objective,
fair, rigorous, uniform and ensure fitness to practise’
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SET 6.9
SET 6.9 raised confusion surrounding the word ‘aegrotat’. Many respondents were
unaware of its definition and as such struggled to understand the meaning of the
SET. It was noted that if course directors cannot understand this, then it was unlikely
that students would. In order to improve clarity we would recommend that the HCPC
provide the definition within the guidance relating to this SET, rather than only within
the glossary.
Recommendation 10: Define the word ‘aegrotat’ within SET 6.9 using the definition
of aegrotat provided within the glossary.
E.g. ‘Assessment regulations must clearly specify requirements for an
aegrotat award (awarded to a student who cannot complete the
degree due to illness) not to provide eligibility for admission to the
Register’
5.7 Conclusion
The findings of this project are mostly consistent with the relevant literature
surrounding preparedness to practise. HCPC’s definition of fitness to practise is
similar to those given by other regulatory bodies. Newly qualified professionals were,
generally, regarded as adequately prepared to practise. There were some concerns
about the ability of some newly qualified professionals to relate to service users and
carers, and also the impact of the variability of both the placement experience and
the role and training of the practice educator.
The results from the project have shown that all of the HCPC’s SETs are important in
preparing newly qualified professionals for practice. Nor was there any evidence that
there should be any additional SETs. There is a recognition that for the SETs to
cover the 16 professions currently regulated by the HCPC they must remain generic
and flexible.
However, there were some enhancements that could be made to the SETS and
guidance. There were some SETs, and also guidance, that could be reworded to
ensure greater clarity. Better links could be made between various documents
relating to the SETs. And there were some SETs where respondents could benefit
from more prescription on how such a SET could be met. Finally, it was clear that,
for some SETs, respondents wanted knowledge on ‘how’ they might meet SETs;
they wanted to access and share real life examples of how different HEIs went about
addressing SETs. The development of such examples would provide a valuable
source of support for HEIs in delivering the SETs and supplement HCPC existing
guidance on how best to provide successful education programmes and ultimately
produce students that are fit to practise.
93
5.8 Limitations of the research project
The project was conducted over a seven month period. It included representation
from all 16 professions regulated by the HCPC. This involved seven different regions
of the UK and utilised an array of data collection methods. The nature and the scope
of this project have provided useful insights regarding fitness to practise. It aims to
improve the experiences of HEI staff, students, service managers, practice
educators, experienced and newly qualified professionals. However, we
acknowledged from the outset that the size of the study would result in challenges
for the research team. As with most research, the project was not without limitations.
5.8.1 Developing the questionnaires
The aim of the project was to collect the opinions from a wide range of participants.
The HCPC allowed us access to a large sample of contact information for newly
qualified professionals and course directors (programme leads). Given the
background and expected knowledge of the different cohorts the Project Advisory
Group to circulate two different questionnaires. An advantage of this approach is that
we could specifically tailor the questions for the different audiences and reduce the
overall length of the questionnaire (for the newly qualified professionals), thus
increasing the potential completion rate. However, using two different questionnaires
did not allow for a direct comparison for each individual SET.
In developing the questionnaire we were faced with a dilemma on how best to
address the issue of fitness to practise. We did not ask newly qualified professionals,
within the questionnaire, the extent to which they felt prepared when entering
practice. Instead, we asked respondents to rank each individual SET in relation to
fitness to practise (ranging from very important to not important at all). This allowed
for a direct mapping of the SETs against fitness to practise. We supplemented this
quantitative data with discussions of definitions of ‘fitness to practise’ and specifically
asked newly qualified professionals to share their experience of the transition from
student to professional within our data collection events.
5.8.2 Respondents of the online survey
We received more results from the survey circulated to newly qualified professionals
than that to course directors. This was expected as newly qualified professionals
represent a much larger population and we had more contact information for this
group. However, due to the smaller amount of data from the other respondents
strong comparisons across the sub-groups were not possible.
5.8.3 Number of respondents in data collection events
As the data collection period fell between the summer months (June-September,
2015) university staff and students alike were often unavailable to attend. This
resulted in fewer participants than originally planned for in the project proposal. The
low numbers of attendees meant that, on numerous occasions, rather than collect
data via world café events we instead used focus groups. Alongside this, to ensure
94
representation across the professions and to cater for those who could not attend the
organised data collection events we conducted telephone interviews. Despite these
challenges we believe that 98 participants in the data collection events, alongside
the 878 completed online surveys, provide a strong basis for the findings reported in
this project.
5.8.4 Service user and carer involvement in data collection events
Whilst a number of service users and carers did contribute to data collection events,
their representation was not as large as we had hoped. Originally we sought to have
exclusive service user focus groups. However, the use of mixed focus groups
resulted in rich discussion between service users and carers and students and staff.
On reflection, the participation of service users and carers may be improved in future
studies by paying them for their involvement (in addition to their travel expenses).
5.8.5 Student involvement in data collection events
Given the time of the year many students were unable to attend the data collection
events due to clinical placements or the annual university break. Furthermore,
findings from the project indicate that current students have little awareness of the
SETs and their role in shaping student education. Instead they appear to have a
greater knowledge of the HCPC’s SoPs. This meant that they struggled to engage
with questions focussed directly on SETs. Despite this we did capture the views of
students, asking them about their experiences of being a student and the key things
that impact on their preparedness to practise.
5.8.6 Naming data quotations
The project was multi-professional and also involved students, service users and
carers. This approach makes it difficult to capture the individual voices within the
qualitative data (focus groups and world cafés). A limitation is that when collecting
and reporting these data it proved impossible to attribute quotes to any specific
profession or individual. However, we were able to achieve this within the open-
ended question results of the online survey and the individual interviews.
95
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Appendix 1: Example of literature review matrix table
Research Country Professions
involved
Area
considered Methods Positive factors Negative factors
Strengths/
Limitations
ASSIA_03
Pal, L. et
al., 2014
United
Kingdom
Palliative and
support care.
Practice
placements
Questionnaire
given to
patients and
then results
discussed with
students.
Interviews and
focus groups
(12 students).
User feedback as a
learning strategy –
method of reflection and
self-evaluation.
User involvement – gain
insight into the lived
experience of illness.
Over time, seeking
feedback enhanced
general confidence in
communicating with
patients.
Receiving feedback
from tutors, and positive
patient feedback,
overwhelmingly
positive. Reassurance,
increase in confidence.
Negative feedback
spurred changes in
behaviour.
Integration of theory
into daily work.
Little evidence of
education
development – largely
reliant on instinct.
Barriers to giving
feedback forms –
embarrassment,
brevity of relationships
with patients,
language barriers, and
not wanting to burden
families.
Usually only receive
feedback in negative
situations.
Patients fear that
negative feedback
may impact future
care. – Unequal power
balance.
Strength: few other
studies in the
literature utilise
user feedback
being cared for by
students.
Limitations: validity
of responses –
selection bias.
ASSIA_04
Bourke, L,
Wright, C.
Australia Health
professionals
Practice
placements
Review of 39
mentoring
papers
Mentoring should be
engaged in willingly.
‘Good mentor’:
Cross-gender and
cross-ethnicity
mentorship occurs
Strength: a
recommended
model for
106
& Wright,
J., 2014
The role of
mentoring in
the rural
setting
empathetic, good role
model, available,
interested, and non-
judgemental.
‘Good mentee’: willing
to accept criticism,
ability to set own
agenda, reassess their
performance and follow
through on suggestions.
Most studies focus on
benefits to mentee but
there are equal benefits
to the mentor – rekindle
excitement.
‘Nurturing model’ – safe
and open environment.
Technology mediated
interactions (emails
texts) provide an honest
form of feedback.
Rural practice is more
interprofessional.
Allows people to reach
career goals.
less often.
The ‘cloning model’
does not allow for
individual growth.
High workload of
professionals restricts
time for mentoring.
Less choice of
potential mentors.
Mentoring time is
unpaid- needs
genuine commitment.
Needs to be careful
conflict resolution so
as not to permanently
damage the
professional
relationship.
mentorship based
on a review of the
literature.
Limitation: the
proposed model
has not been
tested.
107
Appendix 2: Literature review data collection matrix table
Profession Author Method used Number of
participants Country
HCPC
registered
Social Work Bellinger (2010) Literature review United Kingdom
Currer (2009) Report 24 documents United Kingdom
Green et al. (2007) Questionnaire 947 United States
Hingley-Jones & Mandin (2007) Evaluation form 80 United Kingdom
Holmström (2014) Literature review United Kingdom
Kropf (2003) Literature review United States
Mathias-Williams & Thomas (2002) Questionnaire 35 United Kingdom
McCafferty (2005) Report United Kingdom
Rees & Raithby (2012) Questionnaire and focus groups 40 United Kingdom
Tam, Coleman & Kam-Wing (2012) Questionnaire 341 Canada
Physiotherapy Bientzle, Cress & Kimmerle (2013) Observational 76 Germany
Gunn, Hunter & Haas (2012) Interview 10 United Kingdom
Maloney et al. (2013) Survey 34 Australia
Thomson & Hilton (2011) Focus groups and interviews 37 United Kingdom
Occupational
Health Therapy
Hartmann, Nadeau & Tufano
(2013)
Survey 190 United States
Psychology Raque-Bogdan et al. (2012) Survey 22
programmes
United States
Woods et al. (2006) Observational 50 Canada
Young, Brooks & Norman (2007) Observational 24 Canada
Dietetics Paterson, Green & Maunder (2007) Focus group and questionnaires 13 South Africa
Paramedics Michau et al. (2009) Questionnaire 84 Australia
Speech and
Language Therapy
Brumfit et al. (2001) Literature review United Kingdom
Sheepway, Lincoln & McAllister
(2014)
Data analysis of assessment tool 73 Australia
Not Nursing Andrews & Roberts (2003) Literature review United Kingdom
108
HCPC
registered
Barratt (2010) Focus groups 16 United Kingdom
Beccaria et al. (2013) Online survey and focus groups 85 Australia
Billington (2011) Questionnaire Does not say United Kingdom
Boyd & Spatz (2013) Online questionnaire 36 institutions United States
Christiansen & Bell (2010) Focus groups 54 United Kingdom
Derbyshire & Machin (2011) Interviews 8 United Kingdom
Girot (2000) Literature review United Kingdom
Hartigan et al. (2010) Focus groups 28 Ireland
Nelson, Sadler & Surtees (2005) Report 1 university United Kingdom
Orr, McGrouther & McCaig (2014) Literature review United Kingdom
Tee & Cowen (2012) Report 1 university United Kingdom
Unsworth (2011) Report 56 HEIs United Kingdom
Webster et al. (2010) Questionnaire 8 Australia
Wilson & Carryer (2008) Focus groups 15 New Zealand
Medicine Howe et al. (2010) Report of exam board data 118 United Kingdom
Madjar, Bachner & Kushnir (2012) Questionnaire 143 Israel
Morrison (2008) Literature review United Kingdom
Parker (2006) Literature review Australia
Steven et al. (2014) Audio diary entries, focus groups
and interviews
22 United Kingdom
Whiting (2006) Personal commentary/Literature
review
United Kingdom
Midwifery Avis, Malik & Fraser (2013) Diary entries, interviews and
questionnaires
35 United Kingdom
Brintworth (2014) Online survey 263 United Kingdom
Cook & Payne (2012) Literature review United Kingdom
Darra (2006) Literature review United Kingdom
Dow (2008) Literature review United Kingdom
Fraser (2000a) Observational, interviews and
documentary analysis
330
7 institutions
United Kingdom
Fraser (2000b) Observational, interviews and 1 institution United Kingdom
109
documentary analysis
Hunter et al. (2004) Literature review United Kingdom
Young (2012) Observational, focus groups and
interviews
53 United Kingdom
Pharmacy Gallagher (2010) Literature review Ireland
Physical Therapy Black et al. (2010) Reflective journals and interviews 11 United States
Gibbs & Furney (2013) Interviews 15 United States
Ross & Haidet (2011) PPOS?? 49 United States
Dentistry Bullock et al. (2013) Questionnaire and telephone
interviews
21 United Kingdom
Mental Health Conlon (2014) Workshops and evaluation forms 150 United Kingdom
General
Practitioning
Findlay (2012) Interviews 5 United Kingdom
Support Care Pal, Dixon & Faull (2013) Interviews and focus groups 12 United Kingdom
Mixture Medicine and
respiratory therapy
Bandali, Craig & Ziv (2012) Likert scale, interviews and focus
groups
195
Canada and Israel
Allied health Bandali et al. (2008) Literature review Canada
Nursing (n=19),
social work (n=26),
occupational
therapy (n=29),
physiotherapy
(n=10)
Caldwell et al. (2006) Questionnaire 85
United Kingdom
Nursing (n=19),
social work (n=26),
occupational
therapy (n=29),
physiotherapy
(n=10)
Caldwell et al. (2007) Questionnaire 85
United Kingdom
Midwifery (n=2),
social work (n=6),
Callaghan et al. (2008) Focus groups 14
United Kingdom
110
post-registration
health (n=6)
Medicine (=89),
nursing (n=102),
physiotherapy
(n=43)
Ericson, Masiello & Bolinder (2012) Questionnaire 234
Sweden
Medicine (n=113),
nursing (n=234),
physiotherapy
(n=65),
occupational
therapy (n=42)
Falk et al. (2013) Questionnaire 454
Sweden
Medicine (n=33),
social work (n=38)
Fineberg, Wenger & Forrow (2004) Survey 177
United States
Medicine (n=42),
nursing (n=53),
physiotherapy
(n=54)
Goelen et al. (2006) Observational 149 Belgium
Nursing and
midwifery
Grundy (2001) Literature review United Kingdom
Nursing and
midwifery
Hilton & Pollard (2004) Literature review United Kingdom
Medicine, nursing,
social work
Ho et al. (2008) Literature review Canada
Nursing and
midwifery
Holland & Lauder (2012) Literature review United Kingdom
Nursing and
midwifery
Holland et al. (2010) Questionnaire, interviews, focus
groups, curriculum evaluation
311
United Kingdom
Nursing and
midwifery
Hughes (2004) Literature review United Kingdom
Nursing (n=148), Hylin et al. (2007) Questionnaire 348 Sweden
111
medicine (n=100),
physiotherapy
(n=72),
occupational
therapy (n=28)
Medicine, nursing,
pharmacy, dentistry
Kiersma, Plake & Darbishire (2011) Literature review United States
Nursing (n=727)
and midwifery
(n=50)
Lauder et al. (2008) Survey 777
United Kingdom
Nursing, pharmacy,
medicine
Levett-Jones et al. (2012) Literature review Australia
Nursing, dietetics,
public health,
occupational
therapy,
paramedics
McAllister et al. (2013) Observational, focus groups,
interviews
25 Australia
Social Work,
nursing, teaching
Moriarty et al. (2011) Literature review United Kingdom
Physiotherapy
(n=10),
occupational
therapy (n=10)
O’Connor, Cahill & McKay (2012) Interview 20
Ireland
Medicine (n=1154),
social work (n=638)
Preston-Shott & McKimm (2013) Questionnaire 1792
United Kingdom
Nursing, medicine,
occupational
therapy,
physiotherapy
Reeves & Freeth (2002) Observational, focus groups,
interviews, questionnaires
104 United Kingdom
Physiotherapy,
nursing, medicine,
Rowe, Frantz & Bozalek (2012) Literature review United Kingdom,
United States,
112
social work,
occupational
therapy, pharmacy,
paramedics
Canada, Australia
and South Korea
Nursing (n=21),
social work (n=20),
teaching (n=19)
Stanley et al. (2011) Interviews 60
Nursing and
midwifery
Tee & Jowett (2009) Report 1 university United Kingdom
Audiology,
medicine, nursing,
nutrition,
occupational
therapy, pharmacy,
physiotherapy,
psychology, social
work, speech
therapy
Vanier et al. (2013) Literature review Canada
Nursing and
midwifery
Wells & McLoughlin (2014) Literature review United Kingdom
Dentistry, medicine,
nursing,
occupational
therapy, pharmacy,
physical therapy,
physician assistant,
psychology, public
health, social work
Zorek & Raehl (2012) Report 21 documents United States
113
Appendix 3: The SETs
Pro
gra
mm
e A
dm
iss
ion
s
2.1 The admissions procedures must give both the applicant and the
education provider the information they require to make an informed
choice about whether to take up or make an offer of a place on a
programme.
2.2 The admissions procedures must apply selection and entry criteria,
including evidence of a good command of reading, writing and spoken
English.
2.3 The admissions procedures must apply selection and entry criteria,
including criminal convictions checks.
2.4 The admissions procedures must apply selection and entry criteria,
including compliance with any health requirements.
2.5 The admissions procedures must apply selection and entry criteria,
including appropriate academic and/or professional entry standards.
2.6 The admissions procedures must apply selection and entry criteria,
including accreditation of prior (experiential) learning and other inclusion
mechanisms.
2.7 The admissions procedures must ensure that the education provider
has equality and diversity policies in relation to applicants and students,
together with an indication of how these will be implemented and
monitored.
Pro
gra
mm
e m
an
ag
em
en
t a
nd
res
ou
rces
3.1 The programme must have a secure place in the education provider’s
business plan.
3.2 The programme must be effectively managed.
3.3 The programme must have regular monitoring and evaluation systems
in place.
3.4 There must be a named person who has overall professional
responsibility for the programme who must be appropriately qualified
and experienced and, unless other arrangements are agreed, be on the
relevant part of the Register.
3.5 There must be an adequate number of appropriately qualified and
experienced staff in place to deliver an effective programme.
3.6 Subject areas must be taught by staff with relevant specialist expertise
and knowledge.
3.7 A programme for staff development must be in place to ensure
continuing professional and research development.
3.8 The resources to support student learning in all settings must be
effectively used.
3.9 The resources to support student learning in all settings must effectively
support the required learning and teaching activities of the programme.
3.10 The learning resources, including IT facilities, must be appropriate to the
curriculum and must be readily available to students and staff.
3.11 There must be adequate and accessible facilities to support the welfare
and wellbeing of students in all settings.
3.12 There must be a system of academic and pastoral student support in
place.
114
3.13 There must be a student complaints process in place.
3.14 Where students participate as service users in practical and clinical
teaching, appropriate protocols must be used to obtain their consent.
3.15 Throughout the course of the programme, the education provider must
have identified where attendance is mandatory and must have
associated monitoring mechanisms in place.
3.16 There must be a process in place throughout the programme for dealing
with concerns about students’ profession-related conduct.
3.17 Service users and carers must be involved in the programme.
Cu
rric
ulu
m
4.1 The learning outcomes must ensure that those who successfully
complete the programme meet the standards of proficiency for their part
of the Register.
4.2 The programme must reflect the philosophy, core values, skills and
knowledge base as articulated in any relevant curriculum guidance.
4.3 Integration of theory and practice must be central to the curriculum.
4.4 The curriculum must remain relevant to current practice.
4.5 The curriculum must make sure that students understand the
implications of the HCPC’s standards of conduct, performance and
ethics.
4.6 The delivery of the programme must support and develop autonomous
and reflective thinking.
4.7 The delivery of the programme must encourage evidence-based
practice.
4.8 The range of learning and teaching approaches used must be
appropriate to the effective delivery of the curriculum.
4.9 When there is interprofessional learning the profession-specific skills
and knowledge of each professional group must be adequately
addressed.
Pra
cti
ce
pla
ce
me
nts
5.1 Practice placements must be integral to the programme.
5.2 The number, duration and range of practice placements must be
appropriate to support the delivery of the programme and the
achievement of the learning outcomes.
5.3 The practice placement settings must provide a safe and supportive
environment.
5.4 The education provider must maintain a thorough and effective system
for approving and monitoring all placements.
5.5 The placement providers must have equality and diversity policies in
relation to students, together with an indication of how these will be
implemented and monitored.
5.6 There must be an adequate number of appropriately qualified and
experienced staff at the practice placement setting.
5.7 Practice placement educators must have relevant knowledge, skills and
experience.
5.8 Practice placement educators must undertake appropriate practice
placement educator training.
5.9 Practice placement educators must be appropriately registered, unless
other arrangements are agreed.
115
5.10 There must be regular and effective collaboration between the
education provider and the practice placement provider.
5.11 Students, practice placement providers and practice placement
educators must be fully prepared for placement which will include
information about an understanding of:
- The learning outcomes to be achieved;
- The timings and duration of any placement experience and
associated records to be maintained;
- Expectations of professional conduct;
- The assessment procedures including the implications of, and
any action to be taken in the case of, failure to progress; and
- Communication and lines of responsibility.
5.12 Learning, teaching and supervision must encourage safe and effective
practice, independent learning and professional conduct.
5.12 A range of learning and teaching methods that respect the rights and
needs of service users and colleagues must be in place throughout
practice placements.
Ass
ess
me
nt
6.1 The assessment strategy and design must ensure that the student who
successfully completed the programme has met the standards of
proficiency for their part of the Register.
6.2 All assessments must provide a rigorous and effective process by which
compliance with external-reference frameworks can be measured.
6.3 Professional aspects of practice must be integral to the assessment
procedures in both the education setting and practice placement setting.
6.4 Assessment methods must be employed that measure the learning
outcomes.
6.5 The measurement of student performance must be objective and
ensure fitness to practise.
6.6 There must be effective monitoring and evaluation mechanisms in place
to ensure appropriate standards in the assessment.
6.7 Assessment regulations must clearly specify requirements for student
progression and achievement within the programme.
6.8 Assessment regulations, or other relevant policies, must clearly specify
requirements for approved programmes being the only programmes
which contain any reference to an HCPC protected title of part of the
Register in their named award.
6.9 Assessment regulations must clearly specify requirements for an
aegrotat award not to provide eligibility for admission to the Register.
6.10 Assessment regulations must clearly specify requirements for a
procedure for the right of appeal for students.
6.11 Assessment regulations must clearly specify requirements for the
appointment of at least one external examiner who must be
appropriately experienced and qualified and, unless other arrangements
are agreed, be from the relevant part of the Register.
116
Appendix 4: Definitions of fitness to practise
Regulatory
body Definition of fitness to practise
Professions
represented
General
Medical Council
(GMC)
1. To practise safely, doctors must be competent in what they do. They must establish and maintain
effective relationships with patients, respect patients’ autonomy and act responsibly and
appropriately if they or a colleague fall ill and their performance suffers.
2. But these attributes, while essential, are not enough. Doctors have a respected position in society
and their work give them privileged access to patients, some of whom may be vulnerable. A doctor
whose conduct has shown that he cannot justify the trust placed in him should not continue in
unrestricted practice while that remains the case.
3. In short, the public is entitled to expect that their doctor is fit to practise, and follows our principles
of good practice described in Good Medical Practice.
Doctors
Nursing and
Midwifery
Council (NMC)
Being fit to practise requires a nurse or midwife to have the skills, knowledge, good health and good
character to do their job safely and effectively.
All qualified nurses and midwives must follow The Code: Professional standards of practice and behaviour
for nurses and midwives. Every nurse and midwife will be required to apply for revalidation every three
years, demonstrating to us that they are fit to practise safely and effectively.
We will investigate if an allegation is made that a nurse or midwife does not meet our standards for skills,
education and behaviour. If necessary, we will act by removing them from the register permanently or for a
set period of time.
Nurses and
midwives
General Dental
Council (GDC)
There may be doubts about a dental professionals' fitness to practise due to:
health;
conduct, including convictions and cautions; or
performance.
Dentists, clinical
dental technicians,
dental hygienists,
dental nurses,
dental technicians,
dental therapists,
and orthodontic
therapists
Care Council
for Wales
The main purpose of the Care Council’s fitness to practise process is to make sure those on the Register
(registrants) have the skills, knowledge and character to practise their profession safely and effectively.
Social workers (in
Wales)
117
(CCW) Taking action when a registered worker (registrant) does not meet the standards set in the Code of
Practice for Social Care Workers will mean better services for those using social care and improve the
general public’s confidence in social care services. - See more at: http://www.ccwales.org.uk/fitness-to-
practise-2014/#sthash.CxzK0wco.dpuf
General Optical
Council (GOC)
They can investigate allegations about a registrant’s fitness where there is evidence of:
poor professional performance, such as failure to notice signs of eye disease;
physical or mental health problems affecting their work; or
inappropriate behaviour, such as violence or sexual assault, being under the influence of alcohol or
drugs at work, fraud or dishonesty, or a criminal conviction or caution.
Opticians
(optometrists and
dispensing
opticians)
General
Pharmaceutical
Council (GPhC)
We consider a pharmacy professional fit to practise when they can demonstrate the skills, knowledge,
character and health required to do their job safely and effectively.
We describe fitness to practise as a person’s suitability to be on the register without restrictions. In
practical terms, this means: maintaining appropriate standards of proficiency ensuring you are of good
health and good character, and you are adhering to principles of good practice set out in our various,
standards, guidance and advice.
All registrants must complete a fitness to practise declaration with their registration renewal which they
complete once per year. This declaration requires registrants to inform us if there is any reason why their
fitness to practise is impaired.
A pharmacy professional's fitness to practise can be impaired for a number of reasons including
misconduct, lack of competence, ill-health and through having been convicted of a criminal offence.
In addition to this declaration registrants are required to let us know within 7 days if their status changes at
any point during the year.
Registrants are also required to complete continuing professional development, demonstrating their
commitment to keeping up to date with developments in pharmacy practise.
Pharmacists and
pharmacy
technicians
Northern
Ireland Social
Care Council
(NISCC)
Concerns about a social care worker's conduct or practice may be reported to NISCC by employers,
members of the public or other professionals. Information is also referred to us by partner regulators, the
Regulation & Quality Improvement Authority, the police and the court service. We will only take action in
those cases where evidence of serious misconduct is identified such as:
Failure to provide proper care
Theft of money or property
Assault
Social workers (in
Northern Ireland
118
Physical or verbal abuse
Intimidation of a service user, carer or colleague
Engagement an inappropriate relationship or making sexual advances towards a service-user or
carer
Pharmaceutical
Society of
Northern
Ireland (PSNI)
The Pharmaceutical Society NI (the organisation) describe fitness to practise as a pharmacist’s suitability
to be on the register without restrictions. This means: maintaining appropriate standards of proficiency
ensuring they are of good health and good character, and are adhering to principles of good practice set
out in the standards, guidance and advice issued by the Pharmaceutical Society NI.
Reasons which may impair a pharmacist’s fitness to practise include ill-health, lack of the ability to
competently practise as a pharmacist or findings of misconduct including convictions of a criminal offence.
Pharmacists (in
Northern Ireland)
Scottish Social
Services
Council (SSSC)
The Fitness to Practise team investigates concerns about the good character, conduct and competence of
a person applying for registration or a person already registered and takes action where necessary.
Social workers (in
Scotland)
119
Appendix 5: Questionnaire for Course Directors
HCPC questionnaire survey for Course Directors and Professional Leads in Practice
Hello and thank you for taking part in our survey!
This research assesses the role and effectiveness of the Health and Care Professions Council’s standards for pre-registration education and training (SET) and supporting guidance, in ensuring newly qualified professionals are fit to practise. The research has been commissioned by the Health and Care Professions Council (HCPC) and it is being undertaken by The Faculty of Health, Social Care and Education, run jointly by Kingston University and St George's, University of London.
As defined by the Health and Care Professions Council, we refer to “Fitness to practise” as having the skills, knowledge and character to practise the profession safely and effectively. However, "Fitness to practise" is not just about professional performance. It also includes acts by a registrant which may affect public protection or confidence in the profession. This survey should take approximately 15 minutes to complete. You can decide to save your responses and resume answering the survey at a later time. By returning this questionnaire you are consenting to participate in this research. Be assured that your personal information will be treated confidentially.
1. Please indicate, by clicking on the appropriate box, which ONE of the
following best describes your professional status. *
I am a course director in Higher Education
I am a professional lead in practice
I am a service director or manager
I facilitate pre-registration student learning in practice
I am a professional qualified for 2 years or more, but not a professional lead or someone who facilitates student learning in practice
I am a newly qualified professional (2 years or less)
2. Please indicate, by clicking on the appropriate box, which one of the following
professions you are a course director or a professional lead in practice. *
Arts therapist (art/drama/music)
Biomedical scientist
Chiropodist/Podiatrist
Clinical scientist
Dietitian
Hearing aid dispenser
120
Occupational therapist
Operating department practitioner
Orthoptist
Paramedic
Physiotherapist
Practitioner psychologist
Prosthetist/orthotist
Radiographer
Social worker
Speech and language therapist
3. Please indicate, by clicking on the appropriate box, in which one of the
following geographical regions (as defined by HCPC) you are currently
working. *
South West England
North West England
East Midlands England
West Midlands England
East of England
North East England
South East England
Yorkshire and the Humber
London
Scotland
Northern Ireland
Wales
PROGRAMME ADMISSIONS
4. Below are listed the SETs about programme admissions.
Please indicate, by clicking on the appropriate box, how important you think
each of them is in ensuring newly qualified professionals are fit to practise.
SETs Very important
Important Less important
Not important
Not sure
2.1 The admissions procedures must give both the applicant and the education provider the information they require to make an informed choice about whether to take up or make an offer of a place on a programme.
2.2 The admissions procedures must apply selection and
121
5. If you have responded not important or less important to any of the standards
above, please explain why you think they do not help ensure students are
prepared for practice.
6. If you indicated you are ‘not sure’ about the importance of any of the
standards above, please explain, for each standard, the reason why you are
unsure.
entry criteria, including evidence of a good command of reading, writing and spoken English.
2.3 The admissions procedures must apply selection and entry criteria, including criminal convictions checks.
2.4 The admissions procedures must apply selection and entry criteria, including compliance with any health requirements.
2.5 The admissions procedures must apply selection and entry criteria, including appropriate academic and / or professional entry standards.
2.6 The admissions procedures must apply selection and entry criteria, including accreditation of prior (experiential) learning and other inclusion mechanisms.
2.7 The admissions procedures must ensure that the education provider has equality and diversity policies in relation to applicants and students, together with an indication of how these will be implemented and monitored.
122
PROGRAMME MANAGEMENT AND RESOURCES
7. Below are listed the SETs about programme management and resources.
Please indicate, by clicking on the appropriate box, how important you think
each of them is in ensuring newly qualified professionals are fit to practise.
SETs Very important
Important Less important
Not important
Not sure
3.1 The programme must have a secure place in the education provider’s business plan.
3.2 The programme must be effectively managed.
3.3 The programme must have regular monitoring and evaluation systems in place.
3.4 There must be a named person who has overall professional responsibility for the programme who must be appropriately qualified and experienced and, unless other arrangements are agreed, be on the relevant part of the Register.
3.5 There must be an adequate number of appropriately qualified and experienced staff in place to deliver an effective programme.
3.6 Subject areas must be taught by staff with relevant specialist expertise and knowledge.
3.7 A programme for staff development must be in place to ensure continuing professional and research
123
development.
3.8 The resources to support student learning in all settings must be effectively used.
3.9 The resources to support student learning in all settings must effectively support the required learning and teaching activities of the programme.
3.10 The learning resources, including IT facilities, must be appropriate to the curriculum and must be readily available to students and staff.
3.11 There must be adequate and accessible facilities to support the welfare and wellbeing of students in all settings.
3.12 There must be a system of academic and pastoral student support in place.
3.13 There must be a student complaints process in place.
3.14 Where students participate as service users in practical and clinical teaching, appropriate protocols must be used to obtain their consent
3.15 Throughout the course of the programme, the education provider must have identified where attendance is mandatory and must have associated monitoring mechanisms in place.
3.16 There must be a process in place throughout the programme for dealing with concerns about students’ profession-related conduct.
3.17 Service users and carers must be involved in the programme.
124
8. If you have responded not important or less important to any of the standards
above, please explain why you think they do not help ensure students are
prepared for practice.
9. If you indicated you are ‘not sure’ about the importance of any of the
standards above, please explain, for each standard, the reason why you are
unsure.
CURRICULUM
10. Below are listed the SETs about curriculum.
Please indicate, by clicking on the appropriate box, how important you think
each of them is in ensuring newly qualified professionals are fit to practise.
SETs Very important
Important Less important
Not important
Not sure
4.1 The learning outcomes must ensure that those who successfully complete the programme meet the standards of proficiency for their part of the Register.
4.2 The programme must reflect the philosophy, core values, skills and knowledge base as articulated in any relevant curriculum guidance.
4.3 Integration of theory and practice must be central to the curriculum.
4.4 The curriculum must remain relevant to current practice.
4.5 The curriculum must make sure that students understand the implications of the HCPC’s standards of conduct, performance and ethics.
4.6 The delivery of the programme must support
125
and develop autonomous and reflective thinking.
4.7 The delivery of the programme must encourage evidence-based practice.
4.8 The range of learning and teaching approaches used must be appropriate to the effective delivery of the curriculum.
4.9 When there is interprofessional learning the profession-specific skills and knowledge of each professional group must be adequately addressed.
11. If you have responded not important or less important to any of the standards
above, please explain why you think they do not help ensure students are
prepared for practice.
12. If you indicated you are ‘not sure’ about the importance of any of the
standards above, please explain, for each standard, the reason why you are
unsure.
PRACTICE PLACEMENTS
13. Below are listed the SETs about practice placements.
Please indicate, by clicking on the appropriate box, how important you think
each of them is in ensuring newly qualified professionals are fit to practise.
SETs Very important
Important Less important
Not important
Not sure
5.1 Practice placements must be integral to the programme.
5.2 The number, duration and range of practice placements must be appropriate to support the delivery of the programme
126
and the achievement of the learning outcomes.
5.3 The practice placement settings must provide a safe and supportive environment.
5.4 The education provider must maintain a thorough and effective system for approving and monitoring all placements.
5.5 The placement providers must have equality and diversity policies in relation to students, together with an indication of how these will be implemented and monitored.
5.6 There must be an adequate number of appropriately qualified and experienced staff at the practice placement setting.
5.7 Practice placement educators must have relevant knowledge, skills and experience.
5.8 Practice placement educators must undertake appropriate practice placement educator training.
5.9 Practice placement educators must be appropriately registered, unless other arrangements are agreed.
5.10 There must be regular and effective collaboration
127
between the education provider and the practice placement provider.
5.11 Students, practice placement providers and practice placement educators must be fully prepared for placement which will include information about an understanding of: – the learning outcomes to be achieved; – the timings and the duration of any placement experience and associated records to be maintained; – expectations of professional conduct; – the assessment procedures including the implications of, and any action to be taken in the case of, failure to progress; and – communication and lines of responsibility.
5.12 Learning, teaching and supervision must encourage safe and effective practice, independent learning and professional conduct.
5.13 A range of learning and teaching methods that respect the rights and needs of service users and colleagues must be in place throughout practice placements.
14. If you have responded not important or less important to any of the standards
above, please explain why you think they do not help ensure students are
prepared for practice.
15. If you indicated you are ‘not sure’ about the importance of any of the
standards above, please explain, for each standard, the reason why you are
unsure.
128
ASSESSMENT
16. Below are listed the SETs about assessment.
Please indicate, by clicking on the appropriate box, how important you think
each of them is in ensuring newly qualified professionals are fit to practise.
SETs Very important
Important Less important
Not important
Not sure
6.1 The assessment strategy and design must ensure that the student who successfully completes the programme has met the standards of proficiency for their part of the Register.
6.2 All assessments must provide a rigorous and effective process by which compliance with external-reference frameworks can be measured.
6.3 Professional aspects of practice must be integral to the assessment procedures in both the education setting and practice placement setting.
6.4 Assessment methods must be employed that measure the learning outcomes.
6.5 The measurement of student performance must be objective and ensure fitness to practise.
6.6 There must be effective monitoring and evaluation mechanisms in place to ensure appropriate standards in the assessment.
129
6.7 Assessment regulations must clearly specify requirements for student progression and achievement within the programme.
6.8 Assessment regulations, or other relevant policies, must clearly specify requirements for approved programmes being the only programmes which contain any reference to an HCPC protected title or part of the Register in their named award.
6.9 Assessment regulations must clearly specify requirements for an aegrotat award not to provide eligibility for admission to the Register.
6.10 Assessment regulations must clearly specify requirements for a procedure for the right of appeal for students.
6.11 Assessment regulations must clearly specify requirements for the appointment of at least one external examiner who must be appropriately experienced and qualified and, unless other arrangements are agreed, be from the relevant part of the Register.
17. If you have responded not important or less important to any of the standards
above, please explain why you think they do not help ensure students are
prepared for practice.
130
18. If you indicated you are ‘not sure’ about the importance of any of the
standards above, please explain, for each standard, the reason why you are
unsure.
19. Please indicate to what extent do you agree with the following statement:
The Standards of Education and Training ensure that newly qualified
professionals are appropriately prepared for practice.
Strongly agree
Agree
Neither agree or disagree
Disagree
Strongly disagree
20. Please indicate the extent to which guidance on standards of education and
training is useful in providing clarity on the SETs
Very useful
Fairly useful
Undecided
Not very useful
Not at all useful
21. In what way(s), if any, do you think the guidance could be improved?
Submit questionnaire Thank you very much for completing this questionnaire. If you have any comments or queries then please contact Gary Hickey, Co-Investigator working on this project. Email: [email protected] Tel: 020 8725 2242 In addition to this questionnaire we will run data collection events across the UK and a workshop in London between June and August 2015. These events will help us to learn more about your opinions and beliefs regarding the factors impacting on the preparation for practice of newly qualified professionals. If you want to express an interest in taking part please click on the following link. You will be then be asked few questions about your contact details – this should take just a couple of minutes. This will allow us to keep your contact details separated from the anonymous questionnaire you just submitted. Link for the second questionnaire Thank you again for your help with our research!
131
Appendix 6: Questionnaire for newly qualified, experienced professionals, pre-
registration student supervisors and service directors/managers
HCPC questionnaire survey for newly qualified, experienced professionals, pre-registration student supervisors and service directors/managers
Hello and thank you for taking part in our survey!
This research assesses the role and effectiveness of the Health and Care Professions Council’s standards for pre-registration education and training (SET) and supporting guidance, in ensuring newly qualified professionals are fit to practise. The research has been commissioned by the Health and Care Professions Council (HCPC) and it is being undertaken by The Faculty of Health, Social Care and Education, run jointly by Kingston University and St George's, University of London.
As defined by the Health and Care Professions Council, we refer to “Fitness to practise” as having the skills, knowledge and character to practise the profession safely and effectively. However, "Fitness to practise" is not just about professional performance. It also includes acts by a registrant which may affect public protection or confidence in the profession. This survey should take approximately 15 minutes to complete. You can decide to save your responses and resume answering the survey at a later time. By returning this questionnaire you are consenting to participate in this research. Be assured that your personal information will be treated confidentially.
1. Please indicate, by clicking on the appropriate box, which ONE of the following
best describes your professional status. *
I am a course director in Higher Education
I am a professional lead in practice
I am a service director or manager
I facilitate learning for pre-registration students in practice
I am a professional qualified for 2 years or more, but not a professional lead or someone who facilitate student learning in practice
I am a newly qualified professional (2 years or less)
2. Please indicate, by clicking on the appropriate box, which one of the following
best describes your profession. *
Arts therapist (art/drama/music)
Biomedical scientist
Chiropodist/Podiatrist
Clinical scientist
Dietitian
Hearing aid dispenser
Occupational therapist
132
Operating department practitioner
Orthoptist
Paramedic
Physiotherapist
Practitioner psychologist
Prosthetist/orthotist
Radiographer
Social worker
Speech and language therapist
3. Please indicate, by clicking on the appropriate box, in which one of the
following geographical regions (as defined by HCPC) you are currently
working. *
In questions 4 to 8 we are interested in understanding which factors about a programme, in your opinion, are important in the preparation to practise for newly qualified professionals. Please note we are not asking you to rate how well, or otherwise, these factors were managed by your university while you were studying.
PROGRAMME ADMISSIONS
4. Please indicate, by clicking on the appropriate box, how important you think
each factor about programme admissions listed below is in ensuring newly
qualified professionals are fit to practise.
South West England
North West England
East Midlands England
West Midlands England
East of England
North East England
South East England
Yorkshire and the Humber
London
Scotland
Northern Ireland
Wales
Very important
Important Less important
Not important
Not sure
Making sure students prior to starting the course, have a good command of reading, writing and spoken English-language.
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PROGRAMME MANAGEMENT AND RESOURCES
5. Please indicate, by clicking on the appropriate box, how important you think
each factor listed below is in ensuring newly qualified professionals are fit to
practise.
Very important
Important Less important
Not important
Not sure
The quality of the teaching provided.
Lecturers have relevant and specialist knowledge.
Accessibility of student resources such as handbooks and module guides, information technology, text and journals, equipment and materials, specialist and skills lab.
Appropriate opening hours of student facilities such as counselling service and health service.
Ease of gaining access to those student facilities.
Opportunity to contact academic and pastoral support in the theoretical setting.
Before starting the course adequate consideration is given to any health requirements (such as vaccinations and occupational health assessment).
The programme has an academic and professional entry level, including those relating to literacy and numeracy, appropriate to the level and content of the programme.
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Opportunity to contact academic and pastoral support in the practice placement setting.
Existence of a student complaint service.
Existence of a monitoring mechanism for ensuring compulsory attendance of students.
A process for dealing with concerns about students’ profession-related conduct.
Involvement of service users and carers in the programme development, including teaching, assessment and evaluation.
Involvement of service users and carers in the admission process.
CURRICULUM
6. Please indicate, by clicking on the appropriate box, how important you think
each factor listed below is in ensuring newly qualified professionals are fit to
practise.
Very important
Important Less important
Not important
Not sure
Integration of theory and practice within both the theoretical and practical parts of the programme.
Relevance of the curriculum and of the teaching provided.
Ensuring the programme reflects changes and developments in the profession.
Appropriate teaching of the standards of conduct, performance and ethics throughout the programme.
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Supporting students’ autonomous and reflective thinking (through discussion groups, practice simulation, personal development plans, practice placement reviews).
Encouraging evidence based practice.
Inclusion of interprofessional learning as part of the curriculum.
PRACTICE PLACEMENTS
7. Please indicate, by clicking on the appropriate box, how important you think
each factor listed below is in ensuring newly qualified professionals are fit to
practise.
Very important
Important Less important
Not important
Not sure
Inclusion of an adequate number, duration and range of practice placements as part of the programme.
A safe and supportive environment in the practice placement settings.
Placement providers must have transparent equality and diversity policies in relation to students.
Adequate number of qualified and experienced staff supporting students at the practice placement settings.
Support of qualified and experienced practice placement educators.
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Students, practice placement providers and educators are fully informed about all aspects of practice placements (including timings and durations, learning outcomes to be achieved, expectations of professional conduct, assessment procedures).
Encouraging safe and effective practice, independent learning and professional conduct.
Consideration of the rights and needs of service users and other professionals working in the practice placement settings.
ASSESSMENT
8. Please indicate, by clicking on the appropriate box, how important you think
each factor listed below is in ensuring newly qualified professionals are fit to
practise.
Very important
Important Less important
Not important
Not sure
Rigorous and effective assessment process.
Inclusion of professional aspects of practice as an integral part of the assessment procedures both in the education and practice placement settings.
Assessment procedures able to effectively and objectively measure learning outcomes.
Clarity about how students are assessed.
Clarity about what is expected from students at each stage of the programme.
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Clear understanding of who is eligible to apply for registration with the Health and Care Profession Council following programme completion.
Clear procedure for the right of appeal for students.
Appointment of at least one external examiner appropriately experienced and qualified.
9. Please tell us about other factors and issues which in your opinion should be
addressed in the SETs.
10. Aside from the SETs, please tell us about any other factors which in your
opinion have a POSITIVE impact on newly qualified professionals’ fitness to
practise.
11. Aside from the SETs, please tell us about any other factors which in your
opinion have a NEGATIVE impact on newly qualified professionals’ fitness to
practise.
Submit questionnaire Thank you very much for completing this questionnaire! If you have any comments or queries then please contact Gary Hickey, Co-Investigator working on this project. Email: [email protected] Tel: 020 8725 2242 In addition to this questionnaire we will run data collection events across the UK and a workshop in London between June and August 2015. These events will help us to learn more about your opinions and beliefs regarding the factors impacting on the preparation for practice of newly qualified professionals. If you want to express an interest in taking part please click on the following link. You will be then be asked few questions about your contact details – this should take just a couple of minutes. This will allow us to keep your contact details separated from the anonymous questionnaire you just submitted. Please click here Thank you again for your help with our research!
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Appendix 7: Topic guide for mixed focus group
Focus groups – Course Directors, practice educators, experienced
professionals, newly qualified professionals, service managers, students
Welcome and thank you coming along today.
We are researchers from the Faculty of Health, Social Care and Education at
Kingston University and St George’s, University of London. We are working on a
project, funded by the Health Care Professions Council, to assess the role, and
effectiveness, of the Health and Care Professions Council’s (HCPC’s) standards for
pre-registration education and training (SET) and supporting guidance, in preparing
newly qualified professionals for practice. So today we want to explore your views on
the role of the Health and Care Professions Council’s standards of education and
training in ensuring that newly qualified professionals are fit to practise.
The purpose of today is not to come to a consensus so please feel free to disagree
with each other and give alternative views. Though if you agree with each other then
that is fine as well. The purpose is to explore your views and experiences. There are
no right or wrong answers. I stress - it is your views and experiences we are after.
We have a mixture of people here today; Course directors, service managers,
professional leads in practice, experienced professionals, newly qualified
professionals and students. It’s important that we hear from everyone who has
something to say, so please do let people have their say.
We would like to record this meeting. This is so we can accurately capture your
views and analyse the data. The recording will be transcribed but all of the
participants here will be anonymised as will any mention you make of particular
places or people. Is everyone OK with that? As this is being transcribed it is helpful
if just one person speaks at a time.
1. Are there any SETs which you wish to share your views about – either positive or
negative?
- How relevant do you think it is to ensuring that newly qualified staff are prepared
for practice?
Negative only
- How clear do you think this SET is?
- What, if any, changes, would you make to this SET?
- Have you got any suggestions for rewording or replacing this SET?
- NB Probe on SETs raised by the survey
Positive only
- What is it about this SET that you like?
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- NB Probe on SETs raised by the survey
2. Are there any areas which you think are not covered adequately by the SETs?
- NB Probe on any areas that emerge from the survey
3. Are there any aspects of the guidance which you wish to share your views about –
either positive or negative?
Negative only
- What, if any, changes, would you make to this aspect of the guidance?
- What are your views on the clarity of this aspect of the guidance?
- Have you got any suggestions for rewording this?
- NB Probe on issues raised in the survey
Positive only
- What is it about this aspect of the guidance that you like?
- NB Probe on issues raised in the survey
4. How well prepared for practice do you think newly qualified staff are?
- What are your thoughts about the role of clinical/practice educators?
- Are there any ways in which you think students/newly qualified staff could be
better supported?
5. How well prepared do you think newly qualified staff are for interprofessional
working?
- What suggestions do you have for any improvements?
6. How well prepared do you think newly qualified staff are for service user and carer
involvement?
- What suggestions do you have for any improvements?
7. Can you think at any examples of good practice which cover one of the area
addressed in the SETs (e.g. admission, curriculum, practice placement,
assessment…)? You can think about something you personally did, or that has
been done in your university and you think it is worth to be shared.
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Appendix 8: Topic guide for service user focus group
Focus groups – Members of the public
Welcome and thank you coming along today. My name is Gary Hickey and this is x.
We are researchers from the Faculty of Health, Social Care and Education at
Kingston University and St George’s, University of London. We are working on a
project, funded by the Health Care Professions Council, to assess the role, and
effectiveness, of the Health and Care Professions Council’s (HCPC’s) standards for
pre-registration education and training (SET) and supporting guidance, in preparing
newly qualified professionals for practice. So today we want to explore your views on
the extent to which newly qualified professionals are fit to practise.
The purpose of today is not to come to a consensus so please feel free to disagree
with each other and give alternative views. Though if you agree with each other then
that is fine as well. The purpose is to explore your views and experiences of newly
qualified staff and how prepared they are for practice. There are no right or wrong
answers. I stress - it is your views and experiences we are after.
It’s important that we hear from everyone who has something to say, so please do let
people have their say.
We would like to record this meeting. This is so we can accurately capture your
views and analyse the findings. The recording will be transcribed but all of the
participants here will be anonymised as will any mention you make of particular
places or people. Is everyone OK with that? As this is being transcribed it is helpful if
just one person speaks at a time.
1. What is your opinion about the skills and competence of health/social care staff?
- Are there any differences between newly qualified staff and more experienced
staff? If so, what are these differences?
- Are there any ways in which you think students/newly qualified staff could be
better supported?
2. Much care provision involves a range of professions. How well do you think
these professions work together?
- What suggestions do you have for any improvements?
- Are there any differences between newly qualified staff and more experienced
staff? If so, what are these differences?
3. What do you appreciate the most when dealing with health and care
professionals? Can you think at any examples of good practice form newly
qualified staff that you would like to share? Why do you think this was an
example of good practice, what made it particularly valuable?
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Appendix 9: Topic guide for world café events
World Café
Welcome and thank you coming along today.
We are researchers from the Faculty of Health, Social Care and Education at
Kingston University and St George’s, University of London. We are working on a
project, funded by the Health Care Professions Council, to assess the role, and
effectiveness, of the Health and Care Professions Council’s (HCPC’s) standards for
pre-registration education and training (SET) and supporting guidance, in preparing
newly qualified professionals for practice. So today we want to explore your views on
the role of the Health and Care Professions Council’s standards of education and
training in ensuring that newly qualified professionals are fit to practise.
The purpose of today is not to come to a consensus so please feel free to disagree
with each other and give alternative views. Though if you agree with each other then
that is fine as well. The purpose is to explore your views and experiences. There are
no right or wrong answers. I stress - it is your views and experiences we are after.
We have a mixture of people here today; Course directors, service managers,
members of the public, experienced professionals and students. It’s important that
we hear from everyone who has something to say, so please do let people have their
say.
We have four tables. On each table there will be a question for you to discuss. We
will split you into x groups and ask you to spend 10 minutes at each table discussing
the question before moving on – we will let you know when your 10 minutes is up. At
each table there will be someone taking notes and a facilitator who will help keep the
conversation on track. At the end we will spend 10 minutes feeding back key points
raised at the various tables.
1. From the responses collected through the survey it was suggested that the
following SETS were problematic/particularly useful (list). What are your
thoughts?
- NB Probe on any areas that emerge from the survey
2. From the responses collected through the survey it was suggested that the
following aspects of guidance were problematic (list). What are your
thoughts?
Points 1. and 2. are quite well investigated already. I suggest to keep asking the
question and record what emerge, but without probing areas emerged from the
survey.
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3. Can you think at any examples of good practice which cover one of the area
addressed in the SETs (e.g. admission, curriculum, practice placement,
assessment…)? You can think about something you personally did, or that
has been done in your university and you think it is worth to be shared
4. How well prepared do you think newly qualified staff are for interprofessional
working?
5. How well prepared do you think newly qualified staff are for service user and
involvement?
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Appendix 10: Topic guide for individual interviews
Interviews – professional leads in practice of social work and physiotherapy
Welcome and thank you coming along today.
We are researchers from the Faculty of Health, Social Care and Education at
Kingston University and St George’s, University of London. We are working on a
project, funded by the Health Care Professions Council, to assess the role, and
effectiveness, of the Health and Care Professions Council’s (HCPC’s) standards for
pre-registration education and training (SET) and supporting guidance, in preparing
newly qualified professionals for practice. So today we want to explore your views on
the role of the Health and Care Professions Council’s standards of education and
training in ensuring that newly qualified professionals are fit to practise.
The purpose is to explore your views and experiences. There are no right or wrong
answers. I stress - it is your views and experiences we are after.
We would like to record this meeting. This is so we can accurately capture your
views and analyse the findings. The recording will be transcribed you will be
anonymised as will any mention you make of particular places or people. Are you OK
with that?
1. Are there any SETs which you wish to share your views about – either
positive or negative?
- How relevant do you think it is to ensuring that newly qualified staff are
prepared for practice?
Negative only
- How clear do you think this SET is?
- What, if any, changes, would you make to this SET?
- Have you got any suggestions for rewording or replacing this SET?
- NB Probe on SETs raised by the survey
Positive only
- What is it about this SET that you like?
- NB Probe on SETs raised by the survey
2. Are there any areas which you think are not covered adequately by the SETs?
- NB Probe on any areas that emerge from the survey
3. Are there any aspects of the guidance which you wish to share your views
about – either positive or negative?
144
Negative only
- What, if any, changes, would you make to this aspect of the guidance?
- What are your views on the clarity of this aspect of the guidance?
- Have you got any suggestions for rewording this?
- NB Probe on issues raised in the survey
Positive only
- What is it about this aspect of the guidance that you like?
- NB Probe on issues raised in the survey
4. How well prepared for practice do you think newly qualified staff are?
- What are your thoughts about the role of clinical/practice educators?
- Are there any ways in which you think students/newly qualified staff could be
better supported?
5. How well prepared do you think newly qualified staff are for interprofessional
working?
- What suggestions do you have for any improvements?
6. How well prepared do you think newly qualified staff are for service user and
carer involvement?
- What suggestions do you have for any improvements?
7. Can you think at any examples of good practice which cover one of the area
addressed in the SETs (eg admission, curriculum, practice placement,
assessment…)? You can think about something you personally did, or that
has been done in your university and you think it is worth to be shared.
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Appendix 11: Consensus workshop results
Discussion topic Key points
1. The variety and quality of practice
placements has been shown to be crucial
for the fitness to practise of newly qualified
professionals. At the moment, there seems
to be an issue about the effective control
that an education provider is able to have
on the quality standards of its practice
placement providers. Therefore newly
qualified professionals could be more or
less prepared depending on the practice
placement provider they were assigned to
as students.
- Standard 5.2 already exists.
- It has been suggested that the HCPC
should add a standard focused on this
issue.
- How would you word this standard?
The standard 5.2 is appropriate and does
not need changing.
- Could be better linked to the standards
4.1, 4.2 and 4.3.
- We can’t look at SETs in isolation; the
guidance should suggest that they should
all be considered together.
Placements should link theory and practice.
Social work students need to have a
statutory placement in order to gain
employment.
Difficulties associated with guaranteeing
practice placements – could teaching
partnerships offer a solution?
- Need to look at service provision and the
provision of jobs after students graduate.
The HCPC should give specific regulation
on the ‘number, duration and range’ for
each profession.
Placements should meet national curriculum
requirements – in line with professional
bodies.
Regional variations between placements
exist.
2. On the practice placement another key
aspect of the student successfulness
seemed to be the role of the practice
educator. It is considered particularly
important that the practice educator is in
the position to dedicate a good quality time
to the student, for giving them feedback
and for discussing problematic areas and
strengths. In order to be able to do this, the
practice educator must have sufficient time
outside the day to do work. This is not
always feasible due to heavy workloads
and work place organisation. It has been
suggested that the SET should regulate
this aspect, in order to facilitate the
practice educator in his relation with the
employer.
- How would you formulate a new
This is addressed in the standards of
proficiency across all professions.
Should be addressed within the programme
management section.
Need more resources available to achieve
this.
- Currently not logistically possible to
provide dedicated time for mentoring
students. How could you then measure
and enforce it?
Need to look at other models and good
practice examples.
Needs to be a better definition of ‘practice
educator’
- There is a definition in the glossary of the
guidance but it is still not clearly defined.
Some students do not get supervision from
someone in their profession.
146
SET addressing this issue? Boundaries are now so blurred that
supervision comes in all different forms.
Training from the HCPC on how to be a
good mentor. There needs to be similar
documentation across professions.
3. The SET 6.5 states that ‘The measurement
of student performance must be objective
and ensure fitness to practise’. Concerns
have been raised about the word
‘objective’. Specifically, it has been
suggested that since ‘objectivity’ is not
reachable, a more suitable word should be
used.
- How could an alternative wording
be in your opinion?
There is a triangulation of evidence that
occurs to produce ‘objectivity’.
Should the word ‘objective’ by changed to
‘holistic’? Need to look at the whole of the
student rather than a break-down of things
to be assessed.
Progressive assessment = to be objective
we need to look at the quality of evidence.
Capability and competence mean different
things.
Could replace the word ‘must’ with ‘aim to
be’.
It is possible to be objective when you
assess student outcomes – there are very
clear guidelines.
Training assessors will help them to be
objective.
Having a number of assessors reduces
subjectivity.
It is not a single ‘measurement’, students
are constantly being observed and
measured to achieve objectivity.
4. From the literature review and from our
data collection events, it has strongly
emerged that a health and social care
professional should have certain personal
and professional characteristics and
exhibit certain behaviours. These
characteristics are often expressed in
terms of how someone cares, interacts
and empathises with the individual, and
are described under the umbrella of ‘soft
skills’. This was particularly evident from
the opinions expressed by service users.
- In which section do you think this
should be included? (Admission,
curriculum, assessment)
- What might this SET look like?
It is hard to quantify ‘soft skills’.
The term ‘emotional intelligence’ could be
included in a current standard or within the
guidance.
SET 6.3 ‘professional aspects’ needs to
include interpersonal skills.
Necessary professional attributes are
different for each profession, couldn’t
produce a new SET appropriate for all
professions.
- Communication is highly important for all.
- Biomedics and clinical scientists aren’t
interacting with service users in the same
way.
Could link to SET 4.2 ‘values and ethics’.
These attributes are looked at more closely
in the standards of proficiency.
- These standards need to be better linked
147
to the SOPs generally. Within the
introduction section?
Can you teach these elements of
personality or is it inherent within a person?
- Need to have a basic sense of wanting to
be in the profession – “a seed that can
grow and needs to be nurtured”.
- Interactive teaching and training can
definitely help.
Would be useful to provide good practice
examples.
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Appendix 12: Compendium of practice examples
Practice example
Admissions Workforce planning and working alongside the Welsh government; the amount of places on the course matches
the projected number of biomedical scientists required. Designed to keep the workforce buoyant. Removes
placement and employment competition.
Admission interviews
Values-based recruitment with different tasks throughout the day. That alleviates some of the anxiety because if
applicants are not confident with one aspect they can excel in another. They do a written task on NHS values,
which is very reflective. Then they watch a video to see how they react to that. Then there’s a group interview and
then an individual interview.
Multiple mini interviews. There are 7 stations and the applicant comes in and they are asked a question and sit in
the station for 5 minutes. Interviewers don’t talk they just sit and listen, applicants do that 7 times and then leave.
Interviewers ask them a variety of questions. Interviewers don’t come together to talk about their decisions, scores
are added up. So there are 7 individual opinions of a person. There are red flags, so if someone says something
that is unacceptable then it gets red flagged. There is an actress as well, so the actress comes in and sits down
and does a demonstration and the applicant has to respond to it. It really puts them on the spot. It’s purely about
testing their values and what would they do in a situation when they are presented with someone who has done
something wrong? Would they be honest about it?
Involve NHS partners in interviews. Also, get current students to ‘interview’ prospective students.
Students watch a video and are then put into groups for discussion. Service users are involved and invited to make
comments. They very quickly forget that they are being observed and true traits come through (looking for care and
compassion).
Service users design a reflective written piece that asks students to think about a time they needed help or a time
that they were most vulnerable. This is marked by criteria designed by the service users.
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Practice example
Health requirements All students undertake an occupational health assessment in the induction week. Develop a full picture of the
student’s health and if they require any vaccinations. If anything arises then the course leader works with the
student and student support to put measures in place.
Service user involvement
Database of patients, all given training on how to be an educator.
‘Ryan Harper Experience’ – students placed with a family for 24 hours to experience a day in the life of coping with
that illness
Each unique patient encountered the educator visits their home environment and films them to gain a sense of
their experience. These videos are kept in an archive for whenever students may need to draw on examples. Have
videos dating back 20-30 years.
Service user and carer consultative group who are involved at every stage: admissions, curriculum, teaching,
assessment and reviewing and monitoring.
‘Lived Experience Group’ – they coordinate themselves but attend meetings and respond to requests from the
university and students.
Comensus – money is allocated for service user involvement and it is done on a large scale. Service users design
and teach a module for 80 to 100 students. There’s been a book published with the help of service users.
Professional patient interactions – two days a week of practising on a patient in the education setting. Followed by
focus groups and discussions of the lived experience. Students see the same patients over a period of 4 weeks,
they get to know each other and the sessions are relaxed.
Worked with a hospital administrator to recruit service users. Her role was to look after patient satisfaction, so she
was good at getting people involved.
The same service users are involved at admissions, lectures and assessment. Able to see the student’s
progression.
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Practice example
Service user involvement Advocacy in Action – involves a range of stakeholders and service users. They help to design the module and
arrange and organise the class activities. Training is given before teaching and there is a de-briefing afterwards.
Service users are treated as experts and are offered feedback on their performance. Students are able to interview
service users one on one.
Carer involvement Mother and son came in for the same teaching module; the son was the patient and the mother was the carer. The
son was positive about his experience but the mother was emotionally damaged. After the workshop students’
write a post-it-note of what they felt most important from the session.
Curriculum
One workshop session within the final year surrounding the idea of reality in practice. Students work in teams and
simulate managing a clinic. Students learn that they cannot spend an infinite amount of time with one patient.
One module the lecturer pre-recorded the lectures so students listened to them beforehand – PowerPoint and
recorded voice sent by email. When students got to the lecture they were split into small discussion groups.
Students had twice the amount of learning; it was all very interactive and clever.
Reflective practice. 1st year portfolio combined with a 500/600 word reflective piece. 2nd year written piece of work
at the end of a 15 week placement.
Theory and practice Developed a manual called ‘Independent Learning Activities’ for scenarios that students may not be able to
experience on placement, so students still had the resource.
Inter-professional
education
Interprofessional is built up throughout the course. 1st year module with over 800 students and the tutorial groups
are mixed so that they mix with other professions – the tutor may not be from the student’s profession either. 2nd
year module ‘working in teams’ explores the impact of collaboration on patient-centred care. 3rd year module
‘teams in practice’, staff create scenarios and students work together in simulation exercises. 4th year module
around organisations, policy, practice and how the governance of organisations impact professions.
Assignment to present with a group of 4 or 5 different professionals reflecting on the journey of an individual
patient.
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Practice example
Inter-professional
education
Simulation exercises with service users.
Students split into multi-professional groups and a service user explains their individual story. The students discuss
and ask the service user questions, they realise they often have different questions to ask.
Placements ‘Transition placement’ – for 2 weeks the placement educators are asked to pretend the students are newly
qualified staff but then to provide extra support and feedback.
Practice educators
Students involved in the training of practice educators. Students gave a presentation on their experience of
placements, things that had been helpful and things that had not been helpful.
Practice educator assessed student’s skills right from the start and then regularly, to allow the student more and
more independence. Rather than just assessing at the end.
Practice educator training Trainers’ forum held 4 times a year. All trainers and academic staff involved. Meet to discuss problems, things that
have gone well.
Practice placement
coordinators
Ensure students are not going through the programme and only having one type of placement opportunity.
Coordinators attend periodic staff meetings, update the placement staff about the curriculum, involved in
assessment, offer support for learning outcomes, and generate discussions about equity in assessment. If there
are any issues then the lecturer will go out to visit the placement. The coordinator is usually a lecturer so they know
the curriculum and know what will be expected of the student in practice. Regular discussions to see what is
working and what is not. They have a real understanding of both sides.
The placement coordinator is a link between the university and the hospital. He is employed by the hospital but he
also lectures for the university and coordinates the students into the right placements. Once the student qualifies
he then coordinates the preceptorship and advancements and further training. There is a cohesion as it’s all done
through the same person.
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Practice example
Assessment Case studies used in biomedical science. Allows the student to think of it as a patient rather than a sample.
Peer support
Peer teaching – the 3rd year students will teach the 1st year students. The 1st years can ask for advice and the 3rd
years can get feedback on their communication skills.
Newly qualified professionals come in to talk to students about what is expected of them.
Buddy system – older years act as mentors to 1st years throughout their degree and then continued into 1st year as
a newly qualified. The student is reviewed by the buddy and they are a means of getting advice.
Continued professional
development
Newly qualified social workers go through an Assessed and Supported Year in Employment, formal preceptorship
before they become a ‘social worker’.
Service users go out on visits to give CPD talks.